Provider Demographics
NPI:1295482057
Name:WAKE UP WITH MAKEUP BY MERRYL INC
Entity type:Organization
Organization Name:WAKE UP WITH MAKEUP BY MERRYL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERRYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOLB
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:908-670-0064
Mailing Address - Street 1:98 COTTAGE PL
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-5708
Mailing Address - Country:US
Mailing Address - Phone:732-915-4445
Mailing Address - Fax:
Practice Address - Street 1:43 NEW CT
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-5102
Practice Address - Country:US
Practice Address - Phone:732-915-4445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty