| Keep Glowing Medical Spa Llc | |
|
4057 Asbury Ave Ste 21 Tinton Falls NJ 07753-7700 | |
| (848) 217-2662 | |
| Not Available |
| Full Name | Keep Glowing Medical Spa Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4057 Asbury Ave Ste 21, Tinton Falls, New Jersey |
| Authorized Official Name and Position | Michael J Ellis (OWNER) |
| Authorized Official Contact | 8482172660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Keep Glowing Medical Spa Llc 4057 Asbury Ave Ste 21 Tinton Falls NJ 07753-7700 Ph: (848) 217-2662 | Keep Glowing Medical Spa Llc 4057 Asbury Ave Ste 21 Tinton Falls NJ 07753-7700 Ph: (848) 217-2662 |
| NPI Number | 1295447407 |
|---|---|
| Provider Enumeration Date | 12/19/2022 |
| Last Update Date | 01/17/2023 |
| Medicare PECOS PAC ID | 4981075611 |
|---|---|
| Medicare Enrollment ID | O20230117002025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295447407 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Michael Joseph Ellis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972986693 PECOS PAC ID: 7911253224 Enrollment ID: I20180628001980 |
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