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General NPI Number Information
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NPI Number | 1639556640
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Entity Type | Organization
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Legal Business Name | NEW ENGLAND PLASTIC SURGERY CENTER
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 04/28/2015
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Provider Practice Location Address
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Address Line | 8 VISTA DR
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City | OLD LYME
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State | CT
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Zip | 06371-1587
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Country | US
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Telephone | 860-451-5200
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Fax | 718-672-4251
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Provider Business Mailing Address
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Address Line | 12 HALLS RD UNIT 909
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City | OLD LYME
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State | CT
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Zip | 06371-7000
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Country | US
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Telephone | 646-942-7318
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Fax | 718-672-4251
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN C LEE
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Credential | M.D.
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Telephone | 646-942-7318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 047560
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License Number State | CT
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