Provider Demographics
NPI:1235410549
Name:AVRON H LIPSCHITZ MD PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:AVRON H LIPSCHITZ MD PLASTIC SURGERY LLC
Other - Org Name:ATHENA PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AVRON
Authorized Official - Middle Name:HERSCHEL
Authorized Official - Last Name:LIPSCHITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-324-8197
Mailing Address - Street 1:903 SE MONTEREY COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3339
Mailing Address - Country:US
Mailing Address - Phone:772-324-8197
Mailing Address - Fax:772-324-8143
Practice Address - Street 1:903 SE MONTEREY COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3339
Practice Address - Country:US
Practice Address - Phone:727-324-8197
Practice Address - Fax:772-324-8143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108557208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002JAOtherBCBS
FL004417800Medicaid
FLFJ017AMedicare UPIN