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General NPI Number Information
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NPI Number | 1578330965
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Entity Type | Organization
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Legal Business Name | PINK SUGAR PMU AND MED SPA LLC
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 502 HAMBURG TPKE STE 208
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City | WAYNE
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State | NJ
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Zip | 07470-8446
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Country | US
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Telephone | 973-333-9377
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Fax |
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Provider Business Mailing Address
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Address Line | 78 ROLLING VIEWS DR
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City | WOODLAND PARK
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State | NJ
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Zip | 07424-2644
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Country | US
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Telephone | 201-713-6818
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUHAD OMRAN
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Credential |
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Telephone | 201-713-6818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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