Provider Demographics
NPI:1891193348
Name:TANTAWI PLASTICS COSMETIC VASCULAR SURGERY
Entity Type:Organization
Organization Name:TANTAWI PLASTICS COSMETIC VASCULAR SURGERY
Other - Org Name:TANTAWI PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANTAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-232-8298
Mailing Address - Street 1:6935 SPRING VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-2644
Mailing Address - Country:US
Mailing Address - Phone:646-232-8298
Mailing Address - Fax:
Practice Address - Street 1:1717 E VISTA CHINO # A7-427
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-3559
Practice Address - Country:US
Practice Address - Phone:646-232-8298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126218208200000X, 2082S0099X, 2082S0105X, 2086S0102X, 2086S0122X, 2086S0127X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty