Healthcare Provider Details

I. General information

NPI: 1497148910
Provider Name (Legal Business Name): NEW YORK CITY PLASTIC SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2015
Last Update Date: 03/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3039 EMMONS AVE
BROOKLYN NY
11235-2266
US

IV. Provider business mailing address

3039 EMMONS AVE
BROOKLYN NY
11235-2266
US

V. Phone/Fax

Practice location:
  • Phone: 718-222-5999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LEONARD GROSSMAN
Title or Position: TREASURER
Credential:
Phone: 718-222-5999