Provider Demographics
NPI:1063824514
Name:AESTHETIC MEDICAL ASSOCIATES PLLC DBA LIBERTY OBS
Entity Type:Organization
Organization Name:AESTHETIC MEDICAL ASSOCIATES PLLC DBA LIBERTY OBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-888-0018
Mailing Address - Street 1:3701 MAIN ST
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6538
Mailing Address - Country:US
Mailing Address - Phone:718-888-0018
Mailing Address - Fax:
Practice Address - Street 1:3701 MAIN ST
Practice Address - Street 2:SUITE 5B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6538
Practice Address - Country:US
Practice Address - Phone:718-888-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty