Provider Demographics
NPI:1730511874
Name:ULTIMATE HAIR RETAIL CENTER
Entity type:Organization
Organization Name:ULTIMATE HAIR RETAIL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:V
Authorized Official - Last Name:LABITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-447-8060
Mailing Address - Street 1:1297 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4338
Mailing Address - Country:US
Mailing Address - Phone:718-447-8060
Mailing Address - Fax:718-816-0219
Practice Address - Street 1:1297 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4338
Practice Address - Country:US
Practice Address - Phone:718-447-8060
Practice Address - Fax:718-816-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21U61436541332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies