Provider Demographics
NPI:1437190162
Name:SOUTHERN TIER PLASTIC SURGERY ASSOCIATES PC
Entity Type:Organization
Organization Name:SOUTHERN TIER PLASTIC SURGERY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-734-2067
Mailing Address - Street 1:445 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3410
Mailing Address - Country:US
Mailing Address - Phone:607-734-2067
Mailing Address - Fax:607-732-1349
Practice Address - Street 1:445 E WATER ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3410
Practice Address - Country:US
Practice Address - Phone:607-734-2067
Practice Address - Fax:607-732-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1857511174400000X
NY201319174400000X
NY2323781174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01266788Medicaid
NY02581717Medicaid
NY01613441Medicaid
NY01613441Medicaid
NYG04038Medicare UPIN
NY34784EMedicare ID - Type UnspecifiedANTHONY
NY34784GMedicare ID - Type UnspecifiedHEIL
NYE93777Medicare UPIN
NYRA2673Medicare ID - Type UnspecifiedTRZCINSKI