Provider Demographics
NPI:1083069934
Name:KHANH MENDELOWITZ
Entity Type:Organization
Organization Name:KHANH MENDELOWITZ
Other - Org Name:HANOVER SPA SKIN HEALTH & THERAPEUTIC MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-959-4212
Mailing Address - Street 1:648 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2386
Mailing Address - Country:US
Mailing Address - Phone:781-826-4600
Mailing Address - Fax:
Practice Address - Street 1:648 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2386
Practice Address - Country:US
Practice Address - Phone:781-826-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12607225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty