Provider Demographics
NPI:1194979203
Name:PARK EAST PLASTIC SURGERY PC
Entity type:Organization
Organization Name:PARK EAST PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:K
Authorized Official - Last Name:KWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-734-4488
Mailing Address - Street 1:302 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4772
Mailing Address - Country:US
Mailing Address - Phone:212-734-4488
Mailing Address - Fax:212-734-5115
Practice Address - Street 1:302 E 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4772
Practice Address - Country:US
Practice Address - Phone:212-734-4488
Practice Address - Fax:212-734-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60188359261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24L741Medicare PIN