Provider Demographics
NPI:1497290134
Name:ESANA PLASTIC SURGERY CENTER AND MEDSPA LLC
Entity Type:Organization
Organization Name:ESANA PLASTIC SURGERY CENTER AND MEDSPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-562-7662
Mailing Address - Street 1:1 AUDUBON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6433
Mailing Address - Country:US
Mailing Address - Phone:206-592-7662
Mailing Address - Fax:718-672-4251
Practice Address - Street 1:1 AUDUBON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6433
Practice Address - Country:US
Practice Address - Phone:206-592-7662
Practice Address - Fax:718-672-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT411292086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty