Provider Demographics
NPI:1821207994
Name:AESTHETIC & MAXILLOFACIAL SURGERY CENTER OF DARIEN PC
Entity Type:Organization
Organization Name:AESTHETIC & MAXILLOFACIAL SURGERY CENTER OF DARIEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD DMD
Authorized Official - Phone:203-656-4466
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820
Mailing Address - Country:US
Mailing Address - Phone:203-656-4466
Mailing Address - Fax:203-656-4467
Practice Address - Street 1:17 OLD KINGS HIGHWAY SOUTH
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820
Practice Address - Country:US
Practice Address - Phone:203-656-4466
Practice Address - Fax:203-656-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
JCAHO 339920261QA1903X
JCAHO339920261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Not Answered261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care