Provider Demographics
NPI:1104050517
Name:CEAN SURGICAL PLAZA
Entity type:Organization
Organization Name:CEAN SURGICAL PLAZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:FRITZ
Authorized Official - Last Name:CEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-975-5109
Mailing Address - Street 1:1400 5TH AVE
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2584
Mailing Address - Country:US
Mailing Address - Phone:800-975-5109
Mailing Address - Fax:718-732-2511
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:SUITE 106
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2728
Practice Address - Country:US
Practice Address - Phone:800-975-5109
Practice Address - Fax:718-732-2511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225389261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical