Provider Demographics
NPI:1922404094
Name:COSMOPLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:COSMOPLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-490-0036
Mailing Address - Street 1:45 S PARK PL
Mailing Address - Street 2:# 298
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-3924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 N BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2127
Practice Address - Country:US
Practice Address - Phone:929-800-1887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213702-12086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty