Provider Demographics
NPI:1659666386
Name:REGENCY SURGICAL, PLLC
Entity Type:Organization
Organization Name:REGENCY SURGICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-876-7000
Mailing Address - Street 1:60 E 88TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1170
Mailing Address - Country:US
Mailing Address - Phone:212-876-7000
Mailing Address - Fax:
Practice Address - Street 1:60 E 88TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1170
Practice Address - Country:US
Practice Address - Phone:212-876-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAAAASF CERT# 1822174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1822OtherAAAASF, INC.