Esana Plastic Surgery Center and Medspa LLC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

41129 Issued in CT

Legal business name

ESANA PLASTIC SURGERY CENTER AND MEDSPA LLC

Practice address

1 Audubon St
Suite 201
New Haven, CT 06511-6433

Phone

(206) 592-7662

Fax

(718) 672-4251

NPI assigned

Jan 5, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Deborah Pan, M.D.

Title

Partner

Phone

(203) 562-7662

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483574400000",
    "number": "1497290134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 AUDUBON ST",
            "address_2": "SUITE 201",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065116433",
            "telephone_number": "206-592-7662",
            "fax_number": "718-672-4251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 AUDUBON ST",
            "address_2": "SUITE 201",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065116433",
            "telephone_number": "206-592-7662",
            "fax_number": "718-672-4251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESANA PLASTIC SURGERY CENTER AND MEDSPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-05",
        "last_updated": "2017-01-05",
        "status": "A",
        "authorized_official_last_name": "PAN",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "203-562-7662",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CT",
            "license": "41129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Plastic and Reconstructive Surgery Physician in New Haven, CT
• Providers in New Haven, CT by specialty
• Plastic and Reconstructive Surgery Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.