Organization
MIDDLESEX PLASTIC SURGERY CENTER,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARI REBANE-MAZZOTTA MD (PHYSICIAN/OWNER)
(860) 343-0122
Entity
Organization
Contact information
Practice address
535 SAYBROOK RD, MIDDLETOWN, CT 06457-4743
(860) 343-0122
(860) 347-2212
Mailing address
535 SAYBROOK RD, MIDDLETOWN, CT 06457-4743
(860) 343-0122
(860) 347-2212
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
049437
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049437
OWNER OPERATOR LIC #
CT
Enumeration date
07/29/2011
Last updated
07/29/2011
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