Provider Demographics
NPI:1679695589
Name:BERKS PLASTIC SURGERY INSTITUTE PC
Entity Type:Organization
Organization Name:BERKS PLASTIC SURGERY INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-288-9965
Mailing Address - Street 1:50 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3335
Mailing Address - Country:US
Mailing Address - Phone:610-320-0200
Mailing Address - Fax:610-320-9962
Practice Address - Street 1:50 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3335
Practice Address - Country:US
Practice Address - Phone:610-320-0200
Practice Address - Fax:610-320-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA019757Medicare ID - Type Unspecified