Provider Demographics
NPI:1518148618
Name:AESTHETIC FACIAL SURGERY CENTER OF NY
Entity Type:Organization
Organization Name:AESTHETIC FACIAL SURGERY CENTER OF NY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEH
Authorized Official - Middle Name:S
Authorized Official - Last Name:SLUPCHYNSKYJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-628-6464
Mailing Address - Street 1:44 E 65TH ST
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7022
Mailing Address - Country:US
Mailing Address - Phone:212-628-6464
Mailing Address - Fax:212-628-4083
Practice Address - Street 1:44 E 65TH ST
Practice Address - Street 2:SUITE 1-A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7022
Practice Address - Country:US
Practice Address - Phone:212-608-6464
Practice Address - Fax:212-628-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY69922207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01744930Medicaid
NY021331Medicare PIN
NY01744930Medicaid