Provider Demographics
NPI:1497904296
Name:INTERNATIONAL COSMETIC SURGERY
Entity Type:Organization
Organization Name:INTERNATIONAL COSMETIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARROLL
Authorized Official - Middle Name:
Authorized Official - Last Name:LESESNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-570-6318
Mailing Address - Street 1:2 MERCIA LN
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-7068
Mailing Address - Country:US
Mailing Address - Phone:212-570-6318
Mailing Address - Fax:
Practice Address - Street 1:2 MERCIA LN
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-7068
Practice Address - Country:US
Practice Address - Phone:212-570-6318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical