Provider Demographics
NPI:1407441033
Name:HERSPACE MEDSPA CORP
Entity Type:Organization
Organization Name:HERSPACE MEDSPA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEROSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-741-9595
Mailing Address - Street 1:200 WHITE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1160
Mailing Address - Country:US
Mailing Address - Phone:732-741-9595
Mailing Address - Fax:
Practice Address - Street 1:200 WHITE RD STE 111
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1160
Practice Address - Country:US
Practice Address - Phone:732-741-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty