Healthcare Provider Details

I. General information

NPI: 1548563414
Provider Name (Legal Business Name): FIFTH AVE PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 PARK AVE
NEW YORK NY
10075-0327
US

IV. Provider business mailing address

895 PARK AVE
NEW YORK NY
10075-0327
US

V. Phone/Fax

Practice location:
  • Phone: 212-717-2222
  • Fax:
Mailing address:
  • Phone: 212-717-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number196022
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number196022
License Number StateNY

VIII. Authorized Official

Name: DR. ERIC CHA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 212-717-2222