Provider Demographics
NPI:1437989720
Name:STYLE ICONIC
Entity type:Organization
Organization Name:STYLE ICONIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARSEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-261-0370
Mailing Address - Street 1:4066 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2409
Mailing Address - Country:US
Mailing Address - Phone:347-215-2975
Mailing Address - Fax:
Practice Address - Street 1:4066 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2409
Practice Address - Country:US
Practice Address - Phone:347-215-2975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty