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General NPI Number Information
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NPI Number | 1932614658
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Entity Type | Organization
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Legal Business Name | ARTESIA PLASTIC SURGERY, PLLC
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 6044 MAIN ST STE 106
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6883
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Country | US
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Telephone | 716-650-4622
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Fax |
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Provider Business Mailing Address
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Address Line | 6044 MAIN ST STE 106
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6883
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Country | US
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Telephone | 716-650-4622
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHELLE ROK
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Credential |
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Telephone | 716-650-4622
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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 | 183430
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License Number State | NY
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