Provider Demographics
NPI:1578502993
Name:AESTIQUE PLASTIC SURGICAL ASSOCIATES LTD.
Entity Type:Organization
Organization Name:AESTIQUE PLASTIC SURGICAL ASSOCIATES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAZZARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:724-832-7555
Mailing Address - Street 1:1 AESTHETIC WAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-9500
Mailing Address - Country:US
Mailing Address - Phone:724-832-7555
Mailing Address - Fax:724-832-7566
Practice Address - Street 1:1 AESTHETIC WAY
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-9500
Practice Address - Country:US
Practice Address - Phone:724-832-7555
Practice Address - Fax:724-832-7566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020003E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB34488Medicare UPIN
PAS47017Medicare UPIN