Provider Demographics
NPI:1114484763
Name:JEFFERSON VALLEY PLASTIC SURGERY
Entity Type:Organization
Organization Name:JEFFERSON VALLEY PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-827-8159
Mailing Address - Street 1:3650 HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON VLY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3650 HILL BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON VLY
Practice Address - State:NY
Practice Address - Zip Code:10535-1500
Practice Address - Country:US
Practice Address - Phone:631-827-8159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty