Provider Demographics
NPI:1083027593
Name:ALAN M KISNER PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:ALAN M KISNER PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-424-4004
Mailing Address - Street 1:100 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2847
Mailing Address - Country:US
Mailing Address - Phone:631-424-4004
Mailing Address - Fax:631-424-4027
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2847
Practice Address - Country:US
Practice Address - Phone:631-424-4004
Practice Address - Fax:631-424-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1316841174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B12856Medicare UPIN