Organization
INTERNATIONAL COSMETIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARROLL LESESNE (MEMBER)
(212) 570-6318
Entity
Organization
Contact information
Practice address
620 PARK AVE, NEW YORK, NY 10065-6591
(203) 661-8231
Mailing address
2 MERCIA LN, GREENWICH, CT 06830-7068
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
161137-2
NY
Other
Enumeration date
08/12/2010
Last updated
08/12/2010
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