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General NPI Number Information
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NPI Number | 1770129058
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Entity Type | Organization
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Legal Business Name | NORTHEAST PLASTIC SURGERY PLLC
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Dates
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Enumeration Date | 11/21/2019
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Last Update Date | 11/21/2019
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Provider Practice Location Address
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Address Line | 245 5TH AVE FL 3
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City | NEW YORK
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State | NY
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Zip | 10016-8728
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Country | US
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Telephone | 917-708-0018
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Fax |
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Provider Business Mailing Address
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Address Line | 21 SOUTHPORT TER
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City | SOUTHPORT
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State | CT
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Zip | 06890-1492
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAREEF JANDALI
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Credential | MD
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Telephone | 203-604-5865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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