Organization
ELEVATION PLASTIC SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEO RYO OTAKE M.D., PH.D. (MEDICAL DIRECTOR)
(203) 752-0015
Entity
Organization
Contact information
Practice address
60 TEMPLE ST, SUITE 4B, NEW HAVEN, CT 06510-2716
(203) 752-0015
(203) 772-2814
Mailing address
60 TEMPLE ST, SUITE 4B, NEW HAVEN, CT 06510-2716
(203) 752-0015
(203) 772-2814
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
046053
CT
Other
Enumeration date
04/01/2009
Last updated
04/01/2009
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