Provider Demographics
NPI:1750625927
Name:GOLDMAN CENTER FOR FACIAL PLASTIC SURGERY PLLC
Entity type:Organization
Organization Name:GOLDMAN CENTER FOR FACIAL PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:828-278-9230
Mailing Address - Street 1:717 GREENWAY ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:828-278-9230
Mailing Address - Fax:828-263-5686
Practice Address - Street 1:717 GREENWAY RD
Practice Address - Street 2:SUITE A
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4903
Practice Address - Country:US
Practice Address - Phone:828-278-9230
Practice Address - Fax:828-263-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901411207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty