Provider Demographics
NPI:1033570767
Name:EXXCLUSIVE H20 INC
Entity Type:Organization
Organization Name:EXXCLUSIVE H20 INC
Other - Org Name:EXXCLUISVE HAIR INC HAIR REPLACEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATIQUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED HAIR LOSS
Authorized Official - Phone:646-325-4841
Mailing Address - Street 1:2130 1ST AVE APT 212
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3322
Mailing Address - Country:US
Mailing Address - Phone:646-325-4841
Mailing Address - Fax:
Practice Address - Street 1:6 E CLARKE PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-7501
Practice Address - Country:US
Practice Address - Phone:646-325-4841
Practice Address - Fax:646-410-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1744P3200XOtherCERTIFIED HAIR LOSS SPECIALIST