Organization
LICE MAMAS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN E FASSLER MD (MEDICAL DIRECTOR)
(704) 909-9414
Entity
Organization
Contact information
Practice address
54 W 21ST ST RM 706, NEW YORK, NY 10010-7341
(646) 306-8900
Mailing address
54 W 21ST ST RM 706, NEW YORK, NY 10010-7341
(646) 306-8900
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
02/07/2024
Last updated
04/29/2026
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