Provider Demographics
NPI:1487300455
Name:ES MEDICAL SPA LLC
Entity type:Organization
Organization Name:ES MEDICAL SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:201-310-7614
Mailing Address - Street 1:2500 BRUNSWICK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 BRUNSWICK AVE STE 102
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4134
Practice Address - Country:US
Practice Address - Phone:201-310-7614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty