Provider Demographics
NPI:1073748802
Name:AESTHETIC AND RECONSTRUCTIVE PLASTIC SURGERY INC
Entity Type:Organization
Organization Name:AESTHETIC AND RECONSTRUCTIVE PLASTIC SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-267-8723
Mailing Address - Street 1:111 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2900
Mailing Address - Country:US
Mailing Address - Phone:617-267-8723
Mailing Address - Fax:617-527-6870
Practice Address - Street 1:111 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2900
Practice Address - Country:US
Practice Address - Phone:617-267-8723
Practice Address - Fax:617-527-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36338208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty