MEDICARE: MMC PLASTIC SURGERY FPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285952804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MMC PLASTIC SURGERY FPP

Provider Business Mailing Address
First Line	:	PO BOX 30074
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-0074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 64TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4745
Country	:	US
Telephone Number	:	718-283-7022
Fax Number	:

Authorized Official
Title or Position	:	CHIEF, PLASTIC SURGERY
Name	:	DR. LLOYD B GAYLE
Credential	:	MD
Telephone Number	:	718-765-2570

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	12/22/2025

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