Provider Demographics
NPI:1033149935
Name:ADVANCED PLASTIC SURGERY OF LONG ISLAND, PLLC
Entity Type:Organization
Organization Name:ADVANCED PLASTIC SURGERY OF LONG ISLAND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TESSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-377-2738
Mailing Address - Street 1:1800 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566
Mailing Address - Country:US
Mailing Address - Phone:516-377-2738
Mailing Address - Fax:516-377-7705
Practice Address - Street 1:1800 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4530
Practice Address - Country:US
Practice Address - Phone:516-377-2738
Practice Address - Fax:516-377-7705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202643208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY37L801Medicare ID - Type Unspecified