Provider Demographics
NPI:1114191905
Name:AESTHETIC PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:AESTHETIC PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FEINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-498-8400
Mailing Address - Street 1:833 NORTHERN BOULEVARD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5395
Mailing Address - Country:US
Mailing Address - Phone:516-498-8400
Mailing Address - Fax:516-498-8404
Practice Address - Street 1:833 NORTHERN BOULEVARD
Practice Address - Street 2:SUITE 160
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5395
Practice Address - Country:US
Practice Address - Phone:516-498-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1761282086S0122X
NY1879482086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty