Provider Demographics
NPI:1780009928
Name:JS AESTHETICS
Entity Type:Organization
Organization Name:JS AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERBER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-371-7000
Mailing Address - Street 1:2400 PASSAGE KEY TRL
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-9212
Mailing Address - Country:US
Mailing Address - Phone:937-371-7000
Mailing Address - Fax:937-534-0166
Practice Address - Street 1:2400 PASSAGE KEY TRL
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-9212
Practice Address - Country:US
Practice Address - Phone:937-371-7000
Practice Address - Fax:937-534-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007948207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2538025Medicaid