Healthcare Provider Details

I. General information

NPI: 1396156790
Provider Name (Legal Business Name): NEW ORLEANS CENTER FOR AESTHETICS AND PLASTIC SURGERY,LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 NAPOLEON AVE SUITE 920
NEW ORLEANS LA
70115-6357
US

IV. Provider business mailing address

2633 NAPOLEON AVE SUITE 920
NEW ORLEANS LA
70115-6357
US

V. Phone/Fax

Practice location:
  • Phone: 504-533-8848
  • Fax: 504-533-8848
Mailing address:
  • Phone: 504-533-8848
  • Fax: 504-533-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSSELL GERARD HENDRICK JR.
Title or Position: FOUNDER/OWNER
Credential: M.D.
Phone: 504-914-8230