Provider Demographics
NPI:1407043755
Name:CENTER FOR RESTORATIVE BREAST SURGERY LLC
Entity Type:Organization
Organization Name:CENTER FOR RESTORATIVE BREAST SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-529-6679
Mailing Address - Street 1:PO BOX 8664
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70011
Mailing Address - Country:US
Mailing Address - Phone:504-899-2800
Mailing Address - Fax:504-620-3964
Practice Address - Street 1:1717 ST CHARLES AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130
Practice Address - Country:US
Practice Address - Phone:504-899-2800
Practice Address - Fax:504-620-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13291R2086S0122X
LA0212872086S0122X
LA0249722086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CG45Medicare PIN