Healthcare Provider Details

I. General information

NPI: 1598414674
Provider Name (Legal Business Name): AESTHETIC ANESTHESIA NEWTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BOYLSTON ST
NEWTON MA
02459-2871
US

IV. Provider business mailing address

335 BOYLSTON ST
NEWTON MA
02459-2871
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-3223
  • Fax: 617-566-3220
Mailing address:
  • Phone: 617-566-3223
  • Fax: 617-566-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY SPIEGEL
Title or Position: PHYSICIAN
Credential: MD
Phone: 617-566-3223