Provider Demographics
NPI:1417155565
Name:AESTHETICS & PLASTIC SURGERY OF PARK AVE PLLC
Entity Type:Organization
Organization Name:AESTHETICS & PLASTIC SURGERY OF PARK AVE PLLC
Other - Org Name:PARK AVENUE PLASTIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-794-3900
Mailing Address - Street 1:200 LA BONNE VIE DR
Mailing Address - Street 2:C/O DARCY MANAGEMENT OFFICE
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4434
Mailing Address - Country:US
Mailing Address - Phone:631-289-4400
Mailing Address - Fax:631-289-4403
Practice Address - Street 1:655 PARK AVE
Practice Address - Street 2:SUITE NETC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5937
Practice Address - Country:US
Practice Address - Phone:212-794-3900
Practice Address - Fax:212-794-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical