Provider Demographics
NPI:1619380532
Name:NORTHEAST AESTHETIC GROUP LLC
Entity Type:Organization
Organization Name:NORTHEAST AESTHETIC GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AKASH
Authorized Official - Middle Name:ASHOK
Authorized Official - Last Name:BAROT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-908-1278
Mailing Address - Street 1:7519 TORRESDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3335
Mailing Address - Country:US
Mailing Address - Phone:215-335-2220
Mailing Address - Fax:
Practice Address - Street 1:7519 TORRESDALE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3335
Practice Address - Country:US
Practice Address - Phone:215-335-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental