Aesthetic MD Of Ny
Specialist in Southampton, NY. Organization (NPI-2).
NPI number1962857987
StatusActive
Last updated in NPPESApr 27, 2016
Details
- NPI
- 1962857987
- Entity type
- Organization (NPI-2)
- Legal business name
- Aesthetic MD Of Ny
- Organization subpart
- No
- Enumeration date
- Apr 27, 2016
- Last updated
- Apr 27, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | 174108AN | NY | Yes |
Practice location
61 Main St2nd Floor
Southampton, NY 11968-4870
Phone 631-669-2883 · Fax 631-661-0463
Mailing address
Po Box 621Babylon, NY 11702-0621
Phone 631-669-2883 · Fax 631-661-0463
Authorized official
Ronit Adler
Owner
6316692883
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