=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619338126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEIFF CENTER FOR AESTHETIC & RECONSTRUCTIVE SURGERY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2016
-----------------------------------------------------
Last Update Date | 03/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 BANNING ST SUITE 370
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19904-3485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-384-8696
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 ZACHARY CT
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19803-3967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-960-0971
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | BRYAN SEIFF
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 302-384-8696
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | C1-0008706
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------