| Custom Content | Return to Approve Applications Page | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Medspa Center Information | Please provide information about one location only. | ||||||||||
| Medspa Name | Yael Halaas MD PLLC | ||||||||||
| Medspa Address | 120 E 56TH ST RM 800 800 NEW YORK, New York 10022 United States Map It | ||||||||||
| Medspa Email Address | Email hidden; Javascript is required. | ||||||||||
| MedSpa Phone | (212) 688-5955 | ||||||||||
| Website URL | |||||||||||
| Manager Information | |||||||||||
| Manager Name | YAEL Halaas | ||||||||||
| Manager Email | Email hidden; Javascript is required. | ||||||||||
| Manager Cell Phone | (917) 520-2366 | ||||||||||
| ParentApplicationID | cd7367a788ea | ||||||||||
| 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? | 1 | ||||||||||
| Service Provider Information |
| ||||||||||
| Services |
| ||||||||||
| Other | |||||||||||
| Products used in Patient Services |
| ||||||||||
| Other | |||||||||||
| List main vendors for medical supplies |