Provider Demographics
NPI:1982166138
Name:PINCUS PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:PINCUS PLASTIC SURGERY PC
Other - Org Name:PINCUS PLASTIC SURGERY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ARACELY
Authorized Official - Middle Name:D
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-410-0023
Mailing Address - Street 1:50 ROUTE 111 STE 300
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3700
Mailing Address - Country:US
Mailing Address - Phone:631-352-3556
Mailing Address - Fax:631-897-5975
Practice Address - Street 1:44 LAUREL HILL RD
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1637
Practice Address - Country:US
Practice Address - Phone:631-352-3556
Practice Address - Fax:631-897-5975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1245463058OtherNPI