MEDICARE: REJUVASCALP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	843423211	OTHER	NY	HAIR PROSTHESES

General Provider Information

NPI Number	:	1366184392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REJUVASCALP

Provider Business Mailing Address
First Line	:	1734 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1734 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4127
Country	:	US
Telephone Number	:	646-620-3525
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	GUSLENE A BUBAK
Credential	:	TRICHOLOGLIST
Telephone Number	:	646-620-3525

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	01/22/2025

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