Healthcare Provider Details

I. General information

NPI: 1083847834
Provider Name (Legal Business Name): PARK 71 PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 BELLMORE AVE UNIT B
BELLMORE NY
11710-5651
US

IV. Provider business mailing address

2307 BELLMORE AVE UNIT B
BELLMORE NY
11710-5651
US

V. Phone/Fax

Practice location:
  • Phone: 516-308-7070
  • Fax: 516-308-7071
Mailing address:
  • Phone: 201-895-0891
  • Fax: 516-308-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number174830
License Number StateNY

VIII. Authorized Official

Name: KENNETH R FRANCIS
Title or Position: OWNER
Credential: MD
Phone: 201-895-0891