Provider Demographics
NPI:1043420698
Name:PLASTIC SURGERY OF MANHATTAN PC
Entity Type:Organization
Organization Name:PLASTIC SURGERY OF MANHATTAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STAFFORD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROUMAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-672-2824
Mailing Address - Street 1:170 E 77TH ST
Mailing Address - Street 2:SUITE 6D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1912
Mailing Address - Country:US
Mailing Address - Phone:718-672-2824
Mailing Address - Fax:718-672-4251
Practice Address - Street 1:75 E 71ST STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:718-672-2824
Practice Address - Fax:718-672-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166718208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty