Provider Demographics
NPI:1235248162
Name:GARDENS PLASTIC SURGERY
Entity Type:Organization
Organization Name:GARDENS PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-881-8800
Mailing Address - Street 1:11020 RCA CENTER DR
Mailing Address - Street 2:SUITE 2010
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4277
Mailing Address - Country:US
Mailing Address - Phone:561-881-8800
Mailing Address - Fax:561-848-5878
Practice Address - Street 1:11020 RCA CENTER DR
Practice Address - Street 2:SUITE 2010
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4277
Practice Address - Country:US
Practice Address - Phone:561-881-8800
Practice Address - Fax:561-848-5878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00368OtherBLUECROSS BLUESHIELD
FL274352300Medicaid
FL00368OtherBLUECROSS BLUESHIELD