Provider Demographics
NPI:1417394313
Name:ADVANCED AESTHETIC ASSOCIATES, INC.
Entity type:Organization
Organization Name:ADVANCED AESTHETIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORBERTO
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-816-0040
Mailing Address - Street 1:106 GRAND AVE
Mailing Address - Street 2:SUITE 490
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3574
Mailing Address - Country:US
Mailing Address - Phone:201-816-0040
Mailing Address - Fax:201-816-0148
Practice Address - Street 1:106 GRAND AVENUE
Practice Address - Street 2:SUITE 490
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-816-0040
Practice Address - Fax:201-816-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07387500208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH62616Medicare UPIN