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General NPI Number Information
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NPI Number | 1316331978
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Entity Type | Organization
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Legal Business Name | NEW AGE AESTHETICS, LLC
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Dates
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Enumeration Date | 03/22/2015
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Last Update Date | 03/22/2015
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Provider Practice Location Address
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Address Line | 161 MADISON AVE SUITE 9SE
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City | NEW YORK
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State | NY
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Zip | 10016-5421
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Country | US
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Telephone | 844-633-5686
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Fax | 844-633-5686
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Provider Business Mailing Address
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Address Line | 161 MADISON AVE SUITE 9SE
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City | NEW YORK
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State | NY
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Zip | 10016-5421
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Country | US
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Telephone | 844-633-5686
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Fax | 844-633-5686
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | GASPAR ROSARIO
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Credential | N.P.
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Telephone | 844-633-5686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00162800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 304234
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License Number State | NY
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