Healthcare Provider Details

I. General information

NPI: 1568605996
Provider Name (Legal Business Name): BEAUTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MAIN ST
EAST AURORA NY
14052-1636
US

IV. Provider business mailing address

305 MAIN ST
EAST AURORA NY
14052-1636
US

V. Phone/Fax

Practice location:
  • Phone: 716-655-7546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number120905
License Number StateNY

VIII. Authorized Official

Name: DR. KULWANT BHANGOO
Title or Position: DIRECTOR
Credential: M.D.
Phone: 716-655-7456