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General NPI Number Information
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NPI Number | 1548508963
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Entity Type | Organization
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Legal Business Name | NYC RECONSTRUCTIVE SURGERY, PC
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 850 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10075-1845
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Country | US
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Telephone | 212-988-4040
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Fax | 212-988-0527
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Provider Business Mailing Address
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Address Line | 850 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10075-1845
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Country | US
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Telephone | 212-988-4040
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Fax | 212-988-0527
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARRICK E. ANTELL
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Credential | MD
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Telephone | 212-988-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 161860
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License Number State | NY
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