Provider Demographics
NPI:1710546155
Name:IRIE SALON AND SPA
Entity Type:Organization
Organization Name:IRIE SALON AND SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD THERAPIST, MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SENIOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:917-496-4691
Mailing Address - Street 1:895 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4122
Mailing Address - Country:US
Mailing Address - Phone:347-901-6147
Mailing Address - Fax:
Practice Address - Street 1:895 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4122
Practice Address - Country:US
Practice Address - Phone:347-901-6147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ18KT01097200OtherNEW JERSEY OFFICE OF ATTORNEY GENERAL