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General NPI Number Information
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NPI Number | 1962351833
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Entity Type | Organization
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Legal Business Name | THE LICE LOUNGE OF NJ LLC
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Dates
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Enumeration Date | 01/24/2026
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Last Update Date | 01/24/2026
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Provider Practice Location Address
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Address Line | 900D LAKE ST
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City | RAMSEY
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State | NJ
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Zip | 07446-1283
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Country | US
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Telephone | 201-431-3426
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Fax |
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Provider Business Mailing Address
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Address Line | 59 STONE FENCE RD
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City | ALLENDALE
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State | NJ
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Zip | 07401-1851
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Country | US
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Telephone | 646-919-1533
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK A DI STAULO
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Credential | DI STAULO
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Telephone | 201-431-3426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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