=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376427179
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREENWICH STREET MEDICAL AESTHETICS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2025
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 497 GREENWICH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-1314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-245-2499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 497 GREENWICH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-1314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-245-2499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DR. OREN TEPPER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-245-2499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------