Healthcare Provider Details

I. General information

NPI: 1174982375
Provider Name (Legal Business Name): NEW BODY PLASTIC SURGERY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23960 KATY FWY 130
KATY TX
77494-1339
US

IV. Provider business mailing address

23960 KATY FWY 130
KATY TX
77494-1339
US

V. Phone/Fax

Practice location:
  • Phone: 281-347-0096
  • Fax:
Mailing address:
  • Phone: 281-347-0096
  • Fax: 281-347-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM7789
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberM7789
License Number StateTX

VIII. Authorized Official

Name: DR. GEORGIOS ZIAKAS
Title or Position: OWNER
Credential: M.D.
Phone: 281-901-4121