Provider Demographics
NPI:1144600974
Name:BELLISSIMO PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:BELLISSIMO PLASTIC SURGERY LLC
Other - Org Name:BELLISSIMO PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTIMARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-496-6647
Mailing Address - Street 1:5301 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-2194
Mailing Address - Country:US
Mailing Address - Phone:844-496-6647
Mailing Address - Fax:
Practice Address - Street 1:5301 5TH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232
Practice Address - Country:US
Practice Address - Phone:444-966-6478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-06
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430564174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty