1568529055 NPI number — COSMETIC SURGERY SPECIALISTS

Table of content: (NPI 1568529055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568529055 NPI number — COSMETIC SURGERY SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COSMETIC SURGERY SPECIALISTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568529055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 LANGHORNE NEWTOWN RD STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANGHORNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19047-1089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-750-9400
Provider Business Mailing Address Fax Number:
215-750-7400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 LANGHORNE NEWTOWN RD STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANGHORNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19047-1089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-750-9400
Provider Business Practice Location Address Fax Number:
215-750-7400
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRACKUP
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
215-750-9400

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QA0005X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2240312 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 409559 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0177533000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5114215 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 409559 . This is a "PABS HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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