Provider Demographics
NPI:1063464717
Name:PLASTIC COSMETIC AND RESTORATIVE SURGERY PLLC
Entity Type:Organization
Organization Name:PLASTIC COSMETIC AND RESTORATIVE SURGERY PLLC
Other - Org Name:PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CAPUANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-225-0680
Mailing Address - Street 1:2640 RIDGEWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626
Mailing Address - Country:US
Mailing Address - Phone:585-225-0680
Mailing Address - Fax:585-225-1324
Practice Address - Street 1:2640 RIDGEWAY AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626
Practice Address - Country:US
Practice Address - Phone:585-225-0680
Practice Address - Fax:585-225-1324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1052901208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
100585E0OtherPREFERRED CARE
P020105290OtherBCBS AND BLUE CHOICE
B71737Medicare UPIN
NYBA0405Medicare PIN