Provider Demographics
NPI:1629840541
Name:ESSENTIALLY BARE COSMETIC & LASER CLINIC
Entity Type:Organization
Organization Name:ESSENTIALLY BARE COSMETIC & LASER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CIRAFICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-876-1500
Mailing Address - Street 1:777 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1056
Mailing Address - Country:US
Mailing Address - Phone:617-876-1500
Mailing Address - Fax:
Practice Address - Street 1:777 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1056
Practice Address - Country:US
Practice Address - Phone:617-876-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty