Provider Demographics
NPI:1346991270
Name:CAPITAL REGION COSMETIC SURGERY, LLC
Entity Type:Organization
Organization Name:CAPITAL REGION COSMETIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-724-2444
Mailing Address - Street 1:5 ULENSKI DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1103
Mailing Address - Country:US
Mailing Address - Phone:518-724-2444
Mailing Address - Fax:518-724-2445
Practice Address - Street 1:5 ULENSKI DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1103
Practice Address - Country:US
Practice Address - Phone:518-724-2444
Practice Address - Fax:518-724-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty