Provider Demographics
NPI:1306507694
Name:NV MEDICAL AESTHETICS
Entity type:Organization
Organization Name:NV MEDICAL AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:YARAZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-773-2037
Mailing Address - Street 1:1777 HAMBURG TPKE STE 302
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5243
Mailing Address - Country:US
Mailing Address - Phone:973-773-2039
Mailing Address - Fax:973-773-2038
Practice Address - Street 1:1777 HAMBURG TPKE STE 302
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5243
Practice Address - Country:US
Practice Address - Phone:973-773-2039
Practice Address - Fax:973-773-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty