Provider Demographics
NPI:1497991947
Name:COSMETIC SURGERY ASSOCIATES OF NEW YORK, PLLC
Entity Type:Organization
Organization Name:COSMETIC SURGERY ASSOCIATES OF NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-328-7802
Mailing Address - Street 1:10 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-5112
Mailing Address - Country:US
Mailing Address - Phone:914-761-8667
Mailing Address - Fax:
Practice Address - Street 1:10 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-5112
Practice Address - Country:US
Practice Address - Phone:914-761-8667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215759-2174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty