Provider Demographics
NPI:1306866611
Name:AESTHETIC SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:AESTHETIC SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:STUBBMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-437-2378
Mailing Address - Street 1:250 CETRONIA RD.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9168
Mailing Address - Country:US
Mailing Address - Phone:610-437-2378
Mailing Address - Fax:610-820-9983
Practice Address - Street 1:250 CETRONIA RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9168
Practice Address - Country:US
Practice Address - Phone:610-437-2378
Practice Address - Fax:610-820-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1441994OtherHIGHMARK BLUE SHIELD
PA2128720000OtherPERSONAL CHOICE
PA0016697270004Medicaid
PA2128720000OtherKEYSTONE EAST
PA50010330OtherKEYSTONE SENIOR BLUE
PA50010330OtherKEYSTONE CENTRAL
PA2100413OtherAETNA
PA200008760OtherAMERIHEALTH MERCY
PA50010330OtherCAPITAL BLUE CROSS
PA50010330OtherKEYSTONE CENTRAL
PA=========OtherCIGNA
PAH49680Medicare UPIN
PA2128720000OtherKEYSTONE EAST
PAI16469Medicare UPIN
PAE55657Medicare UPIN