Provider Demographics
NPI:1568041473
Name:JUVLONG AESTHETIC DYNAMIC MEDICINE LLC
Entity Type:Organization
Organization Name:JUVLONG AESTHETIC DYNAMIC MEDICINE LLC
Other - Org Name:CLINICMD URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ ALMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-745-6830
Mailing Address - Street 1:296 CLIFTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2223
Mailing Address - Country:US
Mailing Address - Phone:917-745-6830
Mailing Address - Fax:
Practice Address - Street 1:296 CLIFTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2223
Practice Address - Country:US
Practice Address - Phone:917-745-6830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care