Provider Demographics
NPI:1821348202
Name:IMAGE CONSULTANTS PLASTIC SURGERY
Entity Type:Organization
Organization Name:IMAGE CONSULTANTS PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILL / COLLECTIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMSTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:631-379-5284
Mailing Address - Street 1:1480 REDD RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3026
Mailing Address - Country:US
Mailing Address - Phone:915-600-2639
Mailing Address - Fax:915-702-0023
Practice Address - Street 1:1480 REDD ROAD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:915-600-2639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP22482086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty