Provider Demographics
NPI:1942412572
Name:MANHATTAN OCULOFACIAL PLASTIC SURGERY, PC
Entity Type:Organization
Organization Name:MANHATTAN OCULOFACIAL PLASTIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOAZ
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:LISSAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-717-2150
Mailing Address - Street 1:475 E 72ND ST
Mailing Address - Street 2:SUITE#101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4458
Mailing Address - Country:US
Mailing Address - Phone:212-717-2150
Mailing Address - Fax:
Practice Address - Street 1:1036 PARK AVE # 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:212-717-2150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208452207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty