Provider Demographics
NPI:1578330965
Name:PINK SUGAR PMU AND MED SPA LLC
Entity Type:Organization
Organization Name:PINK SUGAR PMU AND MED SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:OMRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-713-6818
Mailing Address - Street 1:78 ROLLING VIEWS DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2644
Mailing Address - Country:US
Mailing Address - Phone:201-713-6818
Mailing Address - Fax:
Practice Address - Street 1:502 HAMBURG TPKE STE 208
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8446
Practice Address - Country:US
Practice Address - Phone:973-333-9377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center