Organization
IRIE SALON AND SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SANDRA SENIOR LMT (LEAD THERAPIST, MANAGER)
(917) 496-4691
Entity
Organization
Contact information
Practice address
895 PALISADE AVE, FORT LEE, NJ 07024-4122
(347) 901-6147
Mailing address
895 PALISADE AVE, FORT LEE, NJ 07024-4122
(347) 901-6147
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18KT01097200
NEW JERSEY OFFICE OF ATTORNEY GENERAL
NJ
Enumeration date
06/10/2019
Last updated
06/10/2019
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