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General NPI Number Information
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NPI Number | 1114114105
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Entity Type | Organization
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Legal Business Name | ADVANCED PLASTIC SURGERY OF NORTHSHORE, P.C.
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 2500 MARCUS AVENUE SUITE, 103
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City | LAKE SUCCESS
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State | NY
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Zip | 11042-1018
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Country | US
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Telephone | 516-354-1330
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Fax | 516-775-5953
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Provider Business Mailing Address
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Address Line | 2500 MARCUS AVENUE SUITE, 103
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City | LAKE SUCCESS
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State | NY
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Zip | 11042-1018
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Country | US
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Telephone | 516-354-1330
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Fax | 516-775-5953
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Authorized Official
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Title or Position | PLASTIC AND HAND SURGEON
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Name | DR. MAHIRA TANOVIC
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Credential | M.D.
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Telephone | 516-354-1330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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