Provider Demographics
NPI:1932586682
Name:NORTHEAST PLASTIC SURGERY CENTER LLC
Entity type:Organization
Organization Name:NORTHEAST PLASTIC SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:PATHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-699-3727
Mailing Address - Street 1:12 HALLS RD
Mailing Address - Street 2:UNIT 878
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-7000
Mailing Address - Country:US
Mailing Address - Phone:917-699-3727
Mailing Address - Fax:718-672-4251
Practice Address - Street 1:5-1 DAVIS ROAD WEST
Practice Address - Street 2:SUITE 3
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371
Practice Address - Country:US
Practice Address - Phone:917-699-3727
Practice Address - Fax:718-672-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0456072086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty