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General NPI Number Information
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NPI Number | 1003354531
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY AND SKINCARE, PLLC
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 630 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10065-6560
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Country | US
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Telephone | 212-220-0776
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Fax | 212-214-0581
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Provider Business Mailing Address
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Address Line | 630 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10065-6560
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Country | US
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Telephone | 212-220-0776
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Fax | 212-214-0581
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SHANALEE ACKERMAN
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Credential |
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Telephone | 425-503-1706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 250439
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License Number State | NY
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