Provider Demographics
NPI:1205982725
Name:AESTHETIC PLASTIC SURGERY CENTER LLC
Entity type:Organization
Organization Name:AESTHETIC PLASTIC SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-222-3700
Mailing Address - Street 1:32 IMPERIAL AVE
Mailing Address - Street 2:2ND
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4328
Mailing Address - Country:US
Mailing Address - Phone:203-222-3700
Mailing Address - Fax:203-222-3703
Practice Address - Street 1:32 IMPERIAL AVE
Practice Address - Street 2:2ND
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4328
Practice Address - Country:US
Practice Address - Phone:203-222-3700
Practice Address - Fax:203-222-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty