Provider Demographics
NPI:1295968469
Name:SPECIALIZED AESTHETICS, P.A.
Entity type:Organization
Organization Name:SPECIALIZED AESTHETICS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-624-7777
Mailing Address - Street 1:2401 PGA BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3590
Mailing Address - Country:US
Mailing Address - Phone:561-624-7777
Mailing Address - Fax:561-624-9995
Practice Address - Street 1:2401 PGA BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3590
Practice Address - Country:US
Practice Address - Phone:561-624-7777
Practice Address - Fax:561-624-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty