Provider Demographics
NPI:1760916936
Name:SOLE WELLNESS & AESTHETICS, LLC
Entity Type:Organization
Organization Name:SOLE WELLNESS & AESTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIFA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-425-7772
Mailing Address - Street 1:2 LAKE AVE APT 7B
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1235 WHITEHORSE MERCERVILLE RD STE 306
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3810
Practice Address - Country:US
Practice Address - Phone:732-305-0891
Practice Address - Fax:732-510-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty