Healthcare Provider Details

I. General information

NPI: 1154766343
Provider Name (Legal Business Name): AESTHETIC SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 POST RD
DARIEN CT
06820-4744
US

IV. Provider business mailing address

722 POST RD
DARIEN CT
06820-4744
US

V. Phone/Fax

Practice location:
  • Phone: 203-656-9999
  • Fax: 203-655-0099
Mailing address:
  • Phone: 203-656-9999
  • Fax: 203-655-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0317
License Number StateCT

VIII. Authorized Official

Name: DR. FREDRIC NEWMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-656-9999