Provider Demographics
NPI:1710319165
Name:NEW ENGLAND MEDICAL AESTHETICS LLC
Entity Type:Organization
Organization Name:NEW ENGLAND MEDICAL AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GLASMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-409-1933
Mailing Address - Street 1:35 NOD RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3826
Mailing Address - Country:US
Mailing Address - Phone:860-409-1933
Mailing Address - Fax:860-409-1931
Practice Address - Street 1:35 NOD RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3826
Practice Address - Country:US
Practice Address - Phone:860-409-1933
Practice Address - Fax:860-409-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027332207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty