Healthcare Provider Details

I. General information

NPI: 1346991957
Provider Name (Legal Business Name): RISIN PLASTIC SURGERY ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 COCOANUT ROW STE B126
PALM BEACH FL
33480-4069
US

IV. Provider business mailing address

PO BOX 326
PALM BEACH FL
33480-0326
US

V. Phone/Fax

Practice location:
  • Phone: 561-515-5787
  • Fax:
Mailing address:
  • Phone: 732-515-5787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL SIMON RISIN
Title or Position: PRESIDENT
Credential: MD
Phone: 561-515-5787