Provider Demographics
NPI:1992332837
Name:GENESIS II HAIR REPLACEMENT STUDIO
Entity type:Organization
Organization Name:GENESIS II HAIR REPLACEMENT STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ELSNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-727-6192
Mailing Address - Street 1:405 E TAFT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3734
Mailing Address - Country:US
Mailing Address - Phone:315-458-1074
Mailing Address - Fax:
Practice Address - Street 1:405 E TAFT RD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-3734
Practice Address - Country:US
Practice Address - Phone:315-458-1074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier