Provider Demographics
NPI:1558613562
Name:LICE LIFTERS NORTHERN NEW JERSEY LLC
Entity Type:Organization
Organization Name:LICE LIFTERS NORTHERN NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAFAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-287-6067
Mailing Address - Street 1:1245 SUNNYFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2219
Mailing Address - Country:US
Mailing Address - Phone:908-917-1963
Mailing Address - Fax:
Practice Address - Street 1:353C US HIGHWAY 46
Practice Address - Street 2:SUITE 215
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2437
Practice Address - Country:US
Practice Address - Phone:973-287-6067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service