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General NPI Number Information
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NPI Number | 1992619217
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Entity Type | Organization
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Legal Business Name | JLYSS AESTHETICS AND LASER LLC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 8400 BUSTLETON AVE STE 309
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City | PHILADELPHIA
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State | PA
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Zip | 19152-1918
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Country | US
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Telephone | 215-668-1613
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Fax | 215-857-2088
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Provider Business Mailing Address
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Address Line | 8400 BUSTLETON AVE STE 309 STE 309
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City | PHILADELPHIA
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State | PA
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Zip | 19152-1918
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Country | US
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Telephone | 215-668-1613
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Fax | 215-857-2088
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Authorized Official
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Title or Position | CO-OWNER
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Name | HAZEL SMITH
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Credential |
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Telephone | 215-253-1801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | NULL
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