Organization
AESTHETEMED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VADIM NISENBOYM (MANAGER)
(786) 966-7878
Entity
Organization
Contact information
Practice address
2100 E HALLANDALE BEACH BLVD, 100, HALLANDALE BEACH, FL 33009
(786) 966-7878
Mailing address
2100 E HALLANDALE BEACH BLVD, 100, HALLANDALE BEACH, FL 33009
(786) 966-7878
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6025783
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
FL
01
—
CE10037989
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
FL
Enumeration date
05/24/2024
Last updated
05/24/2024
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