Provider Demographics
NPI:1215190129
Name:PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-886-8996
Mailing Address - Street 1:3916 PRINCE ST
Mailing Address - Street 2:SUITE 153
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5361
Mailing Address - Country:US
Mailing Address - Phone:718-886-8996
Mailing Address - Fax:718-679-9292
Practice Address - Street 1:3916 PRINCE ST
Practice Address - Street 2:SUITE 153
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5361
Practice Address - Country:US
Practice Address - Phone:718-886-8996
Practice Address - Fax:718-679-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209574208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty