Provider Demographics
NPI:1265729842
Name:FAIRFIELD PLASTIC SURGERY, LLC
Entity type:Organization
Organization Name:FAIRFIELD PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-672-3016
Mailing Address - Street 1:140 SHERMAN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5849
Mailing Address - Country:US
Mailing Address - Phone:718-672-3016
Mailing Address - Fax:718-672-4251
Practice Address - Street 1:140 SHERMAN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5849
Practice Address - Country:US
Practice Address - Phone:718-672-3016
Practice Address - Fax:718-672-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0473232086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100051885Medicare PIN