Provider Demographics
NPI:1407819055
Name:BUCKS COUNTY PLASTIC SURGERY CENTER, PC
Entity Type:Organization
Organization Name:BUCKS COUNTY PLASTIC SURGERY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SKALICKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-633-3470
Mailing Address - Street 1:104 PHEASANT RUN
Mailing Address - Street 2:SUITE 123
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3439
Mailing Address - Country:US
Mailing Address - Phone:215-702-8600
Mailing Address - Fax:215-633-3480
Practice Address - Street 1:104 PHEASANT RUN
Practice Address - Street 2:SUTIE 123
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3439
Practice Address - Country:US
Practice Address - Phone:215-702-8600
Practice Address - Fax:215-633-3480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
747984Medicare ID - Type Unspecified