Provider Demographics
NPI:1700878576
Name:STANISLAW FACIAL PLASTIC SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:STANISLAW FACIAL PLASTIC SURGERY CENTER, LLC
Other - Org Name:FACIAL PLASTIC SURGERY CENTER OF NEW ENGLAND, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:STANISLAW
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:860-409-1515
Mailing Address - Street 1:35 NOD RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3826
Mailing Address - Country:US
Mailing Address - Phone:860-409-1515
Mailing Address - Fax:
Practice Address - Street 1:35 NOD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3826
Practice Address - Country:US
Practice Address - Phone:860-409-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty