Provider Demographics
NPI:1487192233
Name:NSPC PLASTICS
Entity type:Organization
Organization Name:NSPC PLASTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:ZORINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:THOMAS-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC,CPC-I
Authorized Official - Phone:516-442-3461
Mailing Address - Street 1:100 MERRICK RD
Mailing Address - Street 2:SUITE 128 W
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4800
Mailing Address - Country:US
Mailing Address - Phone:516-442-3461
Mailing Address - Fax:516-442-3462
Practice Address - Street 1:100 MERRICK RD
Practice Address - Street 2:SUITE 128 W
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4800
Practice Address - Country:US
Practice Address - Phone:516-442-3461
Practice Address - Fax:516-442-3462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROLOGICAL SURGERY P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254993208200000X
NY278637208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty