Provider Demographics
NPI:1619172970
Name:AESTHETIC PAVILION AMBULATORY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:AESTHETIC PAVILION AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DECORATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-987-9165
Mailing Address - Street 1:2777 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4660
Mailing Address - Country:US
Mailing Address - Phone:718-987-9165
Mailing Address - Fax:718-987-0305
Practice Address - Street 1:2777 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4660
Practice Address - Country:US
Practice Address - Phone:718-987-9165
Practice Address - Fax:718-987-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Not Answered261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch