Provider Demographics
NPI:1013254036
Name:BINGHAMTON PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:BINGHAMTON PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:B
Authorized Official - Last Name:MATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-729-0101
Mailing Address - Street 1:161 RIVERSIDE DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4176
Mailing Address - Country:US
Mailing Address - Phone:607-729-0101
Mailing Address - Fax:607-729-5693
Practice Address - Street 1:161 RIVERSIDE DR
Practice Address - Street 2:SUITE 106
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4176
Practice Address - Country:US
Practice Address - Phone:607-729-0101
Practice Address - Fax:607-729-5693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53748BMedicare UPIN