1295011823 NPI number — GOTHAM PLASTIC SURGERY, PLLC

Table of content: HAYLEY MATEEN CNP (NPI 1982393492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295011823 NPI number — GOTHAM PLASTIC SURGERY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOTHAM PLASTIC SURGERY, PLLC
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:
1295011823
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 E 56TH ST
Provider Second Line Business Mailing Address:
3RD FL
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10022-3204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 E 56TH ST
Provider Second Line Business Practice Location Address:
3RD FL
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-750-7100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
212-750-7100

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  182720 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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