Organization
MRC WEST MEDSPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY DISTEFANO MD (OWNER)
(862) 216-9732
Entity
Organization
Contact information
Practice address
761 BLOOMFIELD AVE, WEST CALDWELL, NJ 07006-6701
(862) 284-3747
(973) 860-1602
Mailing address
761 BLOOMFIELD AVE, WEST CALDWELL, NJ 07006-6701
(862) 284-3747
(973) 860-1602
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
02/21/2022
Last updated
02/21/2022
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