Provider Demographics
NPI:1720224058
Name:KINGS COUNTY PLASTIC SURGERY SERVICES, P.C.
Entity Type:Organization
Organization Name:KINGS COUNTY PLASTIC SURGERY SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-249-7775
Mailing Address - Street 1:600 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1813
Mailing Address - Country:US
Mailing Address - Phone:212-249-7775
Mailing Address - Fax:212-249-7776
Practice Address - Street 1:50 E 69TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5002
Practice Address - Country:US
Practice Address - Phone:212-249-7775
Practice Address - Fax:212-249-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63423Medicare UPIN