Provider Demographics
NPI:1568529055
Name:COSMETIC SURGERY SPECIALISTS
Entity Type:Organization
Organization Name:COSMETIC SURGERY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRACKUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-750-9400
Mailing Address - Street 1:1717 LANGHORNE NEWTOWN RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1089
Mailing Address - Country:US
Mailing Address - Phone:215-750-9400
Mailing Address - Fax:215-750-7400
Practice Address - Street 1:1717 LANGHORNE NEWTOWN RD STE 150
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1089
Practice Address - Country:US
Practice Address - Phone:215-750-9400
Practice Address - Fax:215-750-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261Q00000X, 261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2240312OtherAETNA HMO
PA409559OtherPERSONAL CHOICE
PA0177533000OtherKEYSTONE
PA5114215OtherAETNA PPO
PA409559OtherPABS HIGHMARK
PA2240312OtherAETNA HMO