Provider Demographics
NPI:1598248528
Name:MODEL MANES BEAUTY SALON LLC
Entity Type:Organization
Organization Name:MODEL MANES BEAUTY SALON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-677-4233
Mailing Address - Street 1:1188 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5997
Mailing Address - Country:US
Mailing Address - Phone:347-677-4233
Mailing Address - Fax:
Practice Address - Street 1:1188 NOSTRAND AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1122
Practice Address - Country:US
Practice Address - Phone:347-677-4233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies