Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Ambulatory Surgical |
261QA1903X | 49 | Ambulatory Surgical Center |
| NPI # | 1417155565 |
| LBN Legal business name | AESTHETICS & PLASTIC SURGERY OF PARK AVE PLLC |
| Authorized official | SCOTT WELLS - (DIRECTOR) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 07/10/2007 |
| Last updated | 07/10/2007 - About 19 years ago |
| Identifiers | n/a |
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