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General NPI Number Information
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NPI Number | 1780221804
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Entity Type | Organization
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Legal Business Name | DYM PLASTIC SURGERY PC
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 1165 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10128-1248
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Country | US
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Telephone | 212-920-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 5TH AVE APT 7N
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City | NEW YORK
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State | NY
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Zip | 10029-5208
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Country | US
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Telephone | 917-538-1366
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Fax | 833-821-5297
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOSEPH BRUGESS
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Credential | CPC
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Telephone | 718-532-4050
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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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