Provider Demographics
NPI:1396109138
Name:SYNERGY AESTHETICS & WELLNESS
Entity type:Organization
Organization Name:SYNERGY AESTHETICS & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-661-2584
Mailing Address - Street 1:12501 CANYON FALLS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-5825
Mailing Address - Country:US
Mailing Address - Phone:936-449-8008
Mailing Address - Fax:936-449-8007
Practice Address - Street 1:12501 CANYON FALLS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-5825
Practice Address - Country:US
Practice Address - Phone:936-449-8008
Practice Address - Fax:936-449-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
K9742208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty