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General NPI Number Information
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NPI Number | 1932917358
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Entity Type | Organization
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Legal Business Name | LL ADVANCED AESTHETICS
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 750 BROAD ST STE 104
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4230
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Country | US
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Telephone | 732-687-9212
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Fax | 732-201-5709
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Provider Business Mailing Address
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Address Line | 23 N DELSEA DR UNIT B
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City | CLAYTON
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State | NJ
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Zip | 08312-1637
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Country | US
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Telephone | 856-423-7700
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Fax | 856-423-0823
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LARISSA LOBATO
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Credential | APN
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Telephone | 732-687-9212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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