Provider Demographics
NPI:1972277895
Name:LEYNGOLD INSTITUTE FOR PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:LEYNGOLD INSTITUTE FOR PLASTIC SURGERY PLLC
Other - Org Name:LEYNGOLD INSTITUTE FOR PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEYNGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-233-1269
Mailing Address - Street 1:3015 E GOLDSTONE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1549
Mailing Address - Country:US
Mailing Address - Phone:208-900-4673
Mailing Address - Fax:208-266-5033
Practice Address - Street 1:3015 E GOLDSTONE DR STE 130
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1549
Practice Address - Country:US
Practice Address - Phone:208-900-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty