Provider Demographics
NPI:1457826109
Name:PLASTIC SURGERY PRACTICE OF HOBOKEN PC
Entity Type:Organization
Organization Name:PLASTIC SURGERY PRACTICE OF HOBOKEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TANSAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-439-5160
Mailing Address - Street 1:2631 MERRICK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5784
Mailing Address - Country:US
Mailing Address - Phone:516-439-5160
Mailing Address - Fax:516-439-5161
Practice Address - Street 1:1320 ADAMS ST STE D
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2370
Practice Address - Country:US
Practice Address - Phone:516-439-5160
Practice Address - Fax:516-439-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY239811OtherMEDICAL LICENSE