Healthcare Provider Details

I. General information

NPI: 1821199423
Provider Name (Legal Business Name): PLASTIC SURGERY INSTITUTE OF NEW MEXICO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 MASTHEAD STREET NE
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

3830 MASTHEAD STREET NE
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-8889
  • Fax: 505-842-8886
Mailing address:
  • Phone: 505-842-8889
  • Fax: 505-842-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number96-31
License Number StateNM

VIII. Authorized Official

Name: DR. NEIL T CHEN
Title or Position: OWNER
Credential: MD
Phone: 505-842-8889