Provider Demographics
NPI:1114114105
Name:ADVANCED PLASTIC SURGERY OF NORTHSHORE, P.C.
Entity Type:Organization
Organization Name:ADVANCED PLASTIC SURGERY OF NORTHSHORE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC AND HAND SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-354-1330
Mailing Address - Street 1:2500 MARCUS AVENUE
Mailing Address - Street 2:SUITE, 103
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1018
Mailing Address - Country:US
Mailing Address - Phone:516-354-1330
Mailing Address - Fax:516-775-5953
Practice Address - Street 1:2500 MARCUS AVENUE
Practice Address - Street 2:SUITE, 103
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1018
Practice Address - Country:US
Practice Address - Phone:516-354-1330
Practice Address - Fax:516-775-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty