Azure Aesthetics and Oculofacial Plastic Surgery PC
Organization Active NPI Ophthalmic Plastic and Reconstructive Surgery Physician · Snyder, NY
NPI 1114724465 · NPPES record last updated Feb 25, 2025
Key facts
- NPI
- 1114724465
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmic Plastic and Reconstructive Surgery Physician 207WX0200X
- Legal business name
- AZURE AESTHETICS AND OCULOFACIAL PLASTIC SURGERY PC
- Practice address
- 4590 Main St
Snyder, NY 14226-4548 - Phone
- (585) 319-2284
- NPI assigned
- Feb 25, 2025
- Organization subpart
- No
Authorized official
- Name
- Dr. Mithra Gonzalez, MD
- Title
- MD/Owner
- Phone
- (585) 319-2284
Practitioners 1
-
Mithra Gonzalez, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250328003065 | NY | Part B Supplier - Clinic/Group Practice | 1052834124 |
Receives reassigned benefits from 1 practitioner Practice locations: Snyder, NY; Warsaw, NY |
National Provider Directory
Locations
401 N Main St
Ste 1
Warsaw, NY 14569
Phone (716) 320-3563
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmic Plastic and Reconstructive Surgery Physician |
207WX0200X | Yes |
Addresses
Primary practice location
4590 Main St
Snyder, NY 14226-4548
Mailing address
4590 Main St
Snyder, NY 14226-4548
Phone (585) 319-2284
Other providers in Snyder, NY
- Jack Charles Anchin
- Elisse Marie Antczak
- Satish Arora
- Barbara J Boehler
- Hope Stephanie Bongiorno
- Robert Louis Bork
- Brad Allen Brown
- Hayden Carruth
All providers in Snyder, NY · Ophthalmic Plastic and Reconstructive Surgery Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.