Provider Demographics
NPI:1437764800
Name:SAFARI UNISEX SALON INC
Entity Type:Organization
Organization Name:SAFARI UNISEX SALON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CRANIAL PROSTHETICS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:COSMETOLOGIST
Authorized Official - Phone:516-659-3753
Mailing Address - Street 1:1605 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1534
Mailing Address - Country:US
Mailing Address - Phone:516-569-5530
Mailing Address - Fax:
Practice Address - Street 1:1605 BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1534
Practice Address - Country:US
Practice Address - Phone:516-569-5530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies