Provider Demographics
NPI:1003354531
Name:PLASTIC SURGERY AND SKINCARE, PLLC
Entity Type:Organization
Organization Name:PLASTIC SURGERY AND SKINCARE, PLLC
Other - Org Name:MARNIE NUSSBAUM DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-503-1706
Mailing Address - Street 1:630 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6560
Mailing Address - Country:US
Mailing Address - Phone:212-220-0776
Mailing Address - Fax:212-214-0581
Practice Address - Street 1:630 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6560
Practice Address - Country:US
Practice Address - Phone:212-220-0776
Practice Address - Fax:212-214-0581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250439261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty