Healthcare Provider Details

I. General information

NPI: 1619122652
Provider Name (Legal Business Name): ALLURE PLASTIC SURGERY ENT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 RICHMOND AVE
STATEN ISLAND NY
10314-1500
US

IV. Provider business mailing address

1424 RICHMOND AVE
STATEN ISLAND NY
10314-1500
US

V. Phone/Fax

Practice location:
  • Phone: 718-477-2020
  • Fax: 718-477-2031
Mailing address:
  • Phone: 718-477-2020
  • Fax: 718-477-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number158614-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number220593-1
License Number StateNY

VIII. Authorized Official

Name: MS. MARIA MONTEIRO
Title or Position: MANAGER
Credential:
Phone: 718-477-2020