1730218074 NPI number — FACIAL PLASTIC, RECONSTRUCTIVE & LASER SURGERY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730218074 NPI number — FACIAL PLASTIC, RECONSTRUCTIVE & LASER SURGERY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FACIAL PLASTIC, RECONSTRUCTIVE & LASER 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:
1730218074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
82 N WATER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12601-1721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-454-8025
Provider Business Mailing Address Fax Number:
845-454-8026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82 N WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12601-1721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-454-8025
Provider Business Practice Location Address Fax Number:
845-454-8026
Provider Enumeration Date:
03/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABRAHAM
Authorized Official First Name:
MANOJ
Authorized Official Middle Name:
TIMOTHY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
845-454-8025

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  211519 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YS0123X , with the licence number: 211519 , 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)

  • Identifier: 7539468 . This is a "AETNA PPO POS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000415207001 . This is a "HEALTHNOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10074336 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 363203 . This is a "MVP PLASTIC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3063915 . This is a "OXFORD LIBERTY, FREEDOM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3289877 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 362957 . This is a "MVP ENT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7M7521 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com