Healthcare Provider Details

I. General information

NPI: 1710319165
Provider Name (Legal Business Name): NEW ENGLAND MEDICAL AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 NOD RD
AVON CT
06001-3826
US

IV. Provider business mailing address

35 NOD RD
AVON CT
06001-3826
US

V. Phone/Fax

Practice location:
  • Phone: 860-409-1933
  • Fax: 860-409-1931
Mailing address:
  • Phone: 860-409-1933
  • Fax: 860-409-1931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number027332
License Number StateCT

VIII. Authorized Official

Name: DR. ROSS ALLEN GLASMANN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 860-409-1933