Provider Demographics
NPI:1083847834
Name:PARK 71 PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:PARK 71 PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-878-4642
Mailing Address - Street 1:114 E 71ST ST
Mailing Address - Street 2:SUITE 1W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5040
Mailing Address - Country:US
Mailing Address - Phone:631-878-4642
Mailing Address - Fax:631-878-4280
Practice Address - Street 1:114 E 71ST ST
Practice Address - Street 2:SUITE 1W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5040
Practice Address - Country:US
Practice Address - Phone:631-878-4642
Practice Address - Fax:631-878-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174830261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF89627Medicare UPIN