Provider Demographics
NPI:1619837499
Name:EMBODIED BODY CONTOURING MED SPA
Entity type:Organization
Organization Name:EMBODIED BODY CONTOURING MED SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-638-1198
Mailing Address - Street 1:560 HUDSON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6655
Mailing Address - Country:US
Mailing Address - Phone:201-638-1198
Mailing Address - Fax:212-888-6024
Practice Address - Street 1:560 HUDSON ST STE 301
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6655
Practice Address - Country:US
Practice Address - Phone:201-638-1198
Practice Address - Fax:212-888-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty