Provider Demographics
NPI:1285080416
Name:PLASTIC SURGERY PRACTICE OF CONNECTICUT
Entity type:Organization
Organization Name:PLASTIC SURGERY PRACTICE OF CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-368-1541
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-0263
Mailing Address - Country:US
Mailing Address - Phone:631-368-1541
Mailing Address - Fax:631-368-1538
Practice Address - Street 1:44 AMOGERONE CROSSWAY # 8151
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-9993
Practice Address - Country:US
Practice Address - Phone:631-368-1541
Practice Address - Fax:631-368-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty