Provider Demographics
NPI:1790276814
Name:DARIEN PLASTIC SURGERY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:DARIEN PLASTIC SURGERY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PASSARETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-656-9999
Mailing Address - Street 1:722 POST RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4744
Mailing Address - Country:US
Mailing Address - Phone:203-656-9999
Mailing Address - Fax:718-672-4251
Practice Address - Street 1:722 POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4744
Practice Address - Country:US
Practice Address - Phone:203-656-9999
Practice Address - Fax:718-672-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042094208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty