Provider Demographics
NPI:1962857987
Name:AESTHETIC MD OF NY
Entity Type:Organization
Organization Name:AESTHETIC MD OF NY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONIT
Authorized Official - Middle Name:
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-669-2883
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-0621
Mailing Address - Country:US
Mailing Address - Phone:631-669-2883
Mailing Address - Fax:631-661-0463
Practice Address - Street 1:61 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-4870
Practice Address - Country:US
Practice Address - Phone:631-669-2883
Practice Address - Fax:631-661-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174108AN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty