Provider Demographics
NPI:1821180407
Name:ARISTOCRAT PLASTIC SURGERY PC
Entity type:Organization
Organization Name:ARISTOCRAT PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYVON
Authorized Official - Middle Name:
Authorized Official - Last Name:TEHRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-498-9790
Mailing Address - Street 1:560 NORTHERN BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5100
Mailing Address - Country:US
Mailing Address - Phone:516-498-9790
Mailing Address - Fax:516-498-9796
Practice Address - Street 1:560 NORTHERN BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5100
Practice Address - Country:US
Practice Address - Phone:516-498-9790
Practice Address - Fax:516-498-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214939174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2995192OtherOXFORD PROVIDER ID NUMBER
NYN84003OtherACS HEALTH NET
NY02463385Medicaid
NYP2995192OtherOXFORD PROVIDER ID NUMBER
NY1467F1Medicare ID - Type Unspecified