Provider Demographics
NPI:1134620503
Name:1ST IMPRESSION SALON LLC
Entity type:Organization
Organization Name:1ST IMPRESSION SALON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZAKIYYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SULUKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-970-3888
Mailing Address - Street 1:6818 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2439
Mailing Address - Country:US
Mailing Address - Phone:267-970-3888
Mailing Address - Fax:
Practice Address - Street 1:6818 MARKET ST
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2439
Practice Address - Country:US
Practice Address - Phone:267-970-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACT020639L1744P3200X
1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty