Provider Demographics
NPI:1518153006
Name:THE PLASTIC SURGERY GROUP PC
Entity Type:Organization
Organization Name:THE PLASTIC SURGERY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:
Authorized Official - Last Name:PILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-466-7000
Mailing Address - Street 1:650 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5204
Mailing Address - Country:US
Mailing Address - Phone:516-466-7000
Mailing Address - Fax:516-466-9024
Practice Address - Street 1:650 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5204
Practice Address - Country:US
Practice Address - Phone:516-466-7000
Practice Address - Fax:516-466-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC18029OtherMEDICARE RAILROAD RETIREMENT
NYW23671Medicare PIN