Provider Demographics
NPI:1063248870
Name:SKIN DEEP ELECTROLOGY, LLC
Entity type:Organization
Organization Name:SKIN DEEP ELECTROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ELECTROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMEERAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LE
Authorized Official - Phone:908-343-3863
Mailing Address - Street 1:123 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3066
Mailing Address - Country:US
Mailing Address - Phone:908-343-3863
Mailing Address - Fax:
Practice Address - Street 1:123 GREEN ST
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3066
Practice Address - Country:US
Practice Address - Phone:908-343-3863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty