Healthcare Provider Details

I. General information

NPI: 1285867135
Provider Name (Legal Business Name): DISCREET PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 OCEAN AVE
BROOKLYN NY
11229-1406
US

IV. Provider business mailing address

2120 OCEAN AVE
BROOKLYN NY
11229-1406
US

V. Phone/Fax

Practice location:
  • Phone: 646-515-8303
  • Fax: 718-676-7008
Mailing address:
  • Phone: 646-515-8303
  • Fax: 718-676-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number238761
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number238761
License Number StateNY

VIII. Authorized Official

Name: DR. DANIEL KAUFMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 646-515-8303