# BLUE SKIN LASER SPA, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053149930
- **Authorized official:** LEONOR KHALIFA (OWNER)
- **Authorized official phone:** (917) 227-8416

## Contact information

- **Practice address:** 314 W 231ST ST, BRONX, NY 10463-3805
- **Practice address phone:** (917) 455-5092
- **Mailing address:** 314 W 231ST ST, BRONX, NY 10463-3805

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/23/2024
- **Last updated:** 07/23/2024