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General NPI Number Information
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NPI Number | 1629383732
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL COSMETIC SURGERY
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 620 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10065-6591
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Country | US
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Telephone | 203-661-8231
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Fax |
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Provider Business Mailing Address
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Address Line | 2 MERCIA LN
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City | GREENWICH
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State | CT
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Zip | 06830-7068
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | CARROLL LESESNE
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Credential |
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Telephone | 212-570-6318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 161137-2
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License Number State | NY
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