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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