Provider Demographics
NPI:1215186457
Name:ADVANCED COSMETIC SURGERY & LASER CENTER OF HYDE PARK, INC.
Entity Type:Organization
Organization Name:ADVANCED COSMETIC SURGERY & LASER CENTER OF HYDE PARK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:E
Authorized Official - Last Name:MENDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-351-3223
Mailing Address - Street 1:3805 EDWARDS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1900
Mailing Address - Country:US
Mailing Address - Phone:513-351-3223
Mailing Address - Fax:513-396-8995
Practice Address - Street 1:3805 EDWARDS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1900
Practice Address - Country:US
Practice Address - Phone:513-351-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0753AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical