Provider Demographics
NPI:1477606218
Name:COSMETIC LASER CENTER OF ROCKY HILL
Entity Type:Organization
Organization Name:COSMETIC LASER CENTER OF ROCKY HILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JITESH
Authorized Official - Middle Name:
Authorized Official - Last Name:VACHHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-257-9700
Mailing Address - Street 1:1880 SILAS DEANE HWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1344
Mailing Address - Country:US
Mailing Address - Phone:860-257-9700
Mailing Address - Fax:203-413-4412
Practice Address - Street 1:1880 SILAS DEANE HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1344
Practice Address - Country:US
Practice Address - Phone:860-257-9700
Practice Address - Fax:203-413-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care