Individual
CAP LESESNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 PARK AVE, NEW YORK, NY 10065-6591
(212) 570-6318
Mailing address
620 PARK AVE, NEW YORK, NY 10065-6591
(212) 570-6318
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
161137-2
NY
Other
Enumeration date
10/11/2006
Last updated
02/07/2019
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