Provider Demographics
NPI:1063667046
Name:CYGNUS SURGICAL
Entity Type:Organization
Organization Name:CYGNUS SURGICAL
Other - Org Name:THE WESTON CENTER FOR COSMETIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALEX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-413-4772
Mailing Address - Street 1:301 BERKELEY ST
Mailing Address - Street 2:APT. 2A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2002
Mailing Address - Country:US
Mailing Address - Phone:617-413-4772
Mailing Address - Fax:857-233-5338
Practice Address - Street 1:158 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-2543
Practice Address - Country:US
Practice Address - Phone:781-686-4625
Practice Address - Fax:857-233-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203183207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty