Provider Demographics
NPI:1518646595
Name:RESTORATION BODY ART INC.
Entity Type:Organization
Organization Name:RESTORATION BODY ART INC.
Other - Org Name:RESTORATION BODY ART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FERNICOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-982-4876
Mailing Address - Street 1:573 VALLEY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3552
Mailing Address - Country:US
Mailing Address - Phone:973-789-6523
Mailing Address - Fax:407-650-2754
Practice Address - Street 1:573 VALLEY RD STE 6
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3552
Practice Address - Country:US
Practice Address - Phone:973-789-6523
Practice Address - Fax:407-650-2754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty