Provider Demographics
NPI:1255359600
Name:EAST END PLASTIC, RECONSTRUCTIVE & HAND SURGERY, P.C.
Entity type:Organization
Organization Name:EAST END PLASTIC, RECONSTRUCTIVE & HAND SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:EMANUELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-369-0490
Mailing Address - Street 1:1267 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2673
Mailing Address - Country:US
Mailing Address - Phone:631-369-0490
Mailing Address - Fax:631-369-6421
Practice Address - Street 1:1267 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2673
Practice Address - Country:US
Practice Address - Phone:631-369-0490
Practice Address - Fax:631-369-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2064032082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2127965OtherVYTRA INS. PROVIDER ID #
NY206403-8OtherWORKERS COMP ID #
NY2364740OtherUNITED HEALTHCARE INS. #
NYAA72815OtherMDNY INSURANCE PROVIDER #
NYP831475OtherOXFORD INS. PROVIDER ID #
NY206403-8OtherWORKERS COMP ID #