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General NPI Number Information
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NPI Number | 1619441276
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Entity Type | Organization
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Legal Business Name | DEIFY LASER & BEAUTY LOUNGE
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 134 W. 23RD ST.
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City | NEW YORK
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State | NY
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Zip | 10011
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Country | US
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Telephone | 646-206-2503
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Fax |
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Provider Business Mailing Address
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Address Line | 134 W. 23RD ST.
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City | NEW YORK
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State | NY
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Zip | 10011
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Country | US
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Telephone | 646-206-2503
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MELISSA ROSE CAVANAUGH
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Credential |
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Telephone | 646-206-2503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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