Healthcare Provider Details

I. General information

NPI: 1316000995
Provider Name (Legal Business Name): LONGWOOD PLASTIC SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 CYPRESS ST SUITE 210
BROOKLINE MA
02445-6776
US

IV. Provider business mailing address

235 CYPRESS ST SUITE 210
BROOKLINE MA
02445-6776
US

V. Phone/Fax

Practice location:
  • Phone: 617-383-6250
  • Fax: 617-383-6255
Mailing address:
  • Phone: 617-383-6250
  • Fax: 617-383-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD JAY MORRIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 617-383-6250