Provider Demographics
NPI:1790112548
Name:EXOTICA BEACHWEAR & TANNING INC.
Entity Type:Organization
Organization Name:EXOTICA BEACHWEAR & TANNING INC.
Other - Org Name:EVERYTHING BEAUTY SALON & SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FALZONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-939-3355
Mailing Address - Street 1:156 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1420
Mailing Address - Country:US
Mailing Address - Phone:716-939-3355
Mailing Address - Fax:
Practice Address - Street 1:156 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1420
Practice Address - Country:US
Practice Address - Phone:716-939-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025047-1305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service