Provider Demographics
NPI:1932917358
Name:LL ADVANCED AESTHETICS
Entity type:Organization
Organization Name:LL ADVANCED AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBATO
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:732-687-9212
Mailing Address - Street 1:23 N DELSEA DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08312-1637
Mailing Address - Country:US
Mailing Address - Phone:856-423-7700
Mailing Address - Fax:856-423-0823
Practice Address - Street 1:750 BROAD ST STE 104
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4230
Practice Address - Country:US
Practice Address - Phone:732-687-9212
Practice Address - Fax:888-259-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty