Provider Demographics
NPI:1932614658
Name:ARTESIA PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:ARTESIA PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-650-4622
Mailing Address - Street 1:6044 MAIN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6883
Mailing Address - Country:US
Mailing Address - Phone:716-650-4622
Mailing Address - Fax:
Practice Address - Street 1:6044 MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6883
Practice Address - Country:US
Practice Address - Phone:716-650-4622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1834302086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124014824OtherHMO