Provider Demographics
NPI:1720109325
Name:ADVANCED COSMETIC SURGERY AND LASER CENTER, INC.
Entity type:Organization
Organization Name:ADVANCED COSMETIC SURGERY AND LASER CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RABSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-275-8710
Mailing Address - Street 1:1000 GERMANTOWN PIKE
Mailing Address - Street 2:SUITE E1
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462
Mailing Address - Country:US
Mailing Address - Phone:610-275-8710
Mailing Address - Fax:610-277-2480
Practice Address - Street 1:1000 GERMANTOWN PIKE
Practice Address - Street 2:SUITE E1
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462
Practice Address - Country:US
Practice Address - Phone:610-275-8710
Practice Address - Fax:610-277-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAM0024621E2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0045261000OtherKEYSTONE
PA052663OtherBSPA
PA50002OtherAETNA
PA052663OtherBSPA
PA50002OtherAETNA