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Organization
LASTING IMPRESSION MEDICAL AESTHETICS, LLC
Active
Organization
LASTING IMPRESSION MEDICAL AESTHETICS, LLC
Active
Other names
Lasting Impression Medical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROEL GALOPE DO (OWNER)
(973) 672-2455
Entity
Organization
Contact information
Practice address
25-15 FAIR LAWN AVE LOWR LEVELR, FAIR LAWN, NJ 07410-3434
(908) 432-3228
Mailing address
25-15 FAIR LAWN AVE LOWR LEVELR, FAIR LAWN, NJ 07410-3434
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0110361
—
NJ
Enumeration date
06/16/2020
Last updated
06/16/2020
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