Provider Demographics
NPI:1821216250
Name:STATE OF THE ART PLASTIC SURGERY, P.S.C.
Entity Type:Organization
Organization Name:STATE OF THE ART PLASTIC SURGERY, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ-MARCHAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-620-4070
Mailing Address - Street 1:1353 AVE LUIS VIGOREAUX
Mailing Address - Street 2:PMB 530
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 SAN PATRICIO AVE
Practice Address - Street 2:MARAMAR PLAZA SUITE 805
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-620-4070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-20100Medicare UPIN