Provider Demographics
NPI:1962612507
Name:SRB PLASTIC SURGERY PC
Entity type:Organization
Organization Name:SRB PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STAFFORD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROUMAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-879-7900
Mailing Address - Street 1:SRB PLASTIC SURGERY PC
Mailing Address - Street 2:75 E 71ST STREET
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4251
Mailing Address - Country:US
Mailing Address - Phone:212-879-7900
Mailing Address - Fax:
Practice Address - Street 1:740 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4251
Practice Address - Country:US
Practice Address - Phone:212-879-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166718208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0100923OtherGHI
NYN37868OtherHEALTH NET
NY80H671OtherBLUE CROSS BLUE SHIELD
NYP3806444OtherOXFORD
NYN37868OtherHEALTH NET
NMF66832Medicare UPIN