Provider Demographics
NPI:1457649931
Name:IDEAL FACIAL PLASTIC & LASER SURGERY PC
Entity Type:Organization
Organization Name:IDEAL FACIAL PLASTIC & LASER SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-621-3223
Mailing Address - Street 1:2643 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-5109
Mailing Address - Country:US
Mailing Address - Phone:412-621-3223
Mailing Address - Fax:412-381-3039
Practice Address - Street 1:2643 E CARSON ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-5109
Practice Address - Country:US
Practice Address - Phone:412-621-3223
Practice Address - Fax:412-381-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty