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General NPI Number Information
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NPI Number | 1407171093
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Entity Type | Organization
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Legal Business Name | ENISMAN FREEDMAN SEPULVEDA PLASTIC SURGEONS PC
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 04/07/2010
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Provider Practice Location Address
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Address Line | 207 WASHINGTON ST SUITE 203A
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601-1356
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Country | US
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Telephone | 845-471-0800
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Fax | 845-471-0863
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Provider Business Mailing Address
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Address Line | 207 WASHINGTON ST SUITE 203A
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601-1356
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Country | US
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Telephone | 845-471-0800
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Fax | 845-471-0863
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CELESTINO EDDIE SEPULVEDA JR.
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Credential | M.D.
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Telephone | 914-204-7056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 172205-1
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License Number State | NY
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