Provider Demographics
NPI:1326132275
Name:PLASTIC & RECONSTRUCTIVE SURGERY, P.C.
Entity Type:Organization
Organization Name:PLASTIC & RECONSTRUCTIVE SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPRUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-242-7635
Mailing Address - Street 1:400 E MAIN ST
Mailing Address - Street 2:NORTH BUILDING
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3417
Mailing Address - Country:US
Mailing Address - Phone:914-242-7610
Mailing Address - Fax:914-241-3239
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:NORTH BUILDING
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3417
Practice Address - Country:US
Practice Address - Phone:914-242-7610
Practice Address - Fax:914-241-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY21A401Medicare PIN
NY40L301Medicare PIN
NY804161Medicare PIN
NY79J831Medicare PIN
NY1749F1Medicare PIN
NY21A402Medicare PIN