Provider Demographics
NPI:1407171093
Name:ENISMAN FREEDMAN SEPULVEDA PLASTIC SURGEONS PC
Entity Type:Organization
Organization Name:ENISMAN FREEDMAN SEPULVEDA PLASTIC SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CELESTINO
Authorized Official - Middle Name:EDDIE
Authorized Official - Last Name:SEPULVEDA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:914-204-7056
Mailing Address - Street 1:207 WASHINGTON ST
Mailing Address - Street 2:SUITE 203A
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1356
Mailing Address - Country:US
Mailing Address - Phone:845-471-0800
Mailing Address - Fax:845-471-0863
Practice Address - Street 1:207 WASHINGTON ST
Practice Address - Street 2:SUITE 203A
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1356
Practice Address - Country:US
Practice Address - Phone:845-471-0800
Practice Address - Fax:845-471-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172205-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty