MEDICARE: PLASTIC SURGERY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	209574	NY

General Provider Information

NPI Number	:	1215190129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLASTIC SURGERY PLLC

Provider Business Mailing Address
First Line	:	3916 PRINCE ST
Second Line	:	SUITE 153
City	:	FLUSHING
State	:	NY
Zip	:	11354-5361
Country	:	US
Telephone Number	:	718-886-8996
Fax Number	:	718-679-9292

Provider Business Practice Location Address
First Line	:	3916 PRINCE ST
Second Line	:	SUITE 153
City	:	FLUSHING
State	:	NY
Zip	:	11354-5361
Country	:	US
Telephone Number	:	718-886-8996
Fax Number	:	718-679-9292

Authorized Official
Title or Position	:	MANAGER
Name	:	STEVE LEE
Credential	:	M.D.
Telephone Number	:	718-886-8996

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	12/28/2015

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