| NPI | 1912756677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARI REITZEN-BASTIDAS Owner 347-557-8368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck |
| Enumeration Date | 2024-05-15 |
| Last Update Date | 2024-09-03 |