| Custom Content | Return to Approve Applications Page | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Medspa Center Information | Please provide information about one location only. | |||||||||||||||
| Medspa Name | Esteem Medical Aesthetics and Wellness | |||||||||||||||
| Medspa Address | 3026 Tilghman St 105 & 106 Allentown, Pennsylvania 18104 United States Map It | |||||||||||||||
| Medspa Email Address | Email hidden; Javascript is required. | |||||||||||||||
| MedSpa Phone | (484) 500-7878 | |||||||||||||||
| Website URL | esteembyjekt.com | |||||||||||||||
| Manager Information | ||||||||||||||||
| Manager Name | Jami Avellini | |||||||||||||||
| Manager Email | Email hidden; Javascript is required. | |||||||||||||||
| Manager Cell Phone | (347) 512-5807 | |||||||||||||||
| ParentApplicationID | d1849d4e541f | |||||||||||||||
| Medical Director for this Location | ||||||||||||||||
| Add New Medical Director | ||||||||||||||||
| Medical Director Information | ||||||||||||||||
| Medical Director Name | ||||||||||||||||
| Medical Director Email | ||||||||||||||||
| Medical School (or Nursing School if Nurse Practitioner) | ||||||||||||||||
| Degree | ||||||||||||||||
| Primary Practice Name | ||||||||||||||||
| Primary Practice Phone | ||||||||||||||||
| NPI # | ||||||||||||||||
| License Number | ||||||||||||||||
| License State | ||||||||||||||||
| Staff Information | ||||||||||||||||
| How many service providers work at the location? | 2 | |||||||||||||||
| Service Provider Information |
| |||||||||||||||
| Services |
| |||||||||||||||
| Other | Threads | |||||||||||||||
| Products used in Patient Services |
| |||||||||||||||
| Other | Nutrofol | |||||||||||||||
| List main vendors for medical supplies | Henry Shein |
