Provider Demographics
NPI:1457578668
Name:CENTER FOR PLASTIC AND AESTHETIC SURGERY, PC
Entity Type:Organization
Organization Name:CENTER FOR PLASTIC AND AESTHETIC SURGERY, PC
Other - Org Name:STEPHEN A GOLDSTEIN, MD, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBIK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:303-708-8234
Mailing Address - Street 1:125 INVERNESS DR E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5137
Mailing Address - Country:US
Mailing Address - Phone:303-708-8234
Mailing Address - Fax:303-649-9694
Practice Address - Street 1:125 INVERNESS DR E
Practice Address - Street 2:SUITE 200
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5137
Practice Address - Country:US
Practice Address - Phone:303-708-8234
Practice Address - Fax:303-649-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04023610Medicaid
COCEJ0908OtherGROUP BCBS #
COJ0908Medicare ID - Type UnspecifiedGROUP MEDICARE #