Provider Demographics
NPI:1588611552
Name:YARROW BAY PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:YARROW BAY PLASTIC SURGERY, PLLC
Other - Org Name:LIEBERTZ PLASTIC SURGERY AT YARROW BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LIEBERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-822-0300
Mailing Address - Street 1:5209 LAKE WASHINGTON BLVD,
Mailing Address - Street 2:SUITE 115
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7355
Mailing Address - Country:US
Mailing Address - Phone:425-822-0300
Mailing Address - Fax:425-822-4999
Practice Address - Street 1:5209 LAKE WASHINGTON BLVD,
Practice Address - Street 2:SUITE 115
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7355
Practice Address - Country:US
Practice Address - Phone:425-822-0300
Practice Address - Fax:425-822-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAI52940Medicare UPIN