Provider Demographics
NPI:1871875880
Name:NYCPLASTICSURG PLLC
Entity type:Organization
Organization Name:NYCPLASTICSURG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:GERARDO
Authorized Official - Last Name:MAGANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-652-1232
Mailing Address - Street 1:935 PARK AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0212
Mailing Address - Country:US
Mailing Address - Phone:801-652-1232
Mailing Address - Fax:212-628-8881
Practice Address - Street 1:935 PARK AVE STE 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0212
Practice Address - Country:US
Practice Address - Phone:801-652-1232
Practice Address - Fax:212-628-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239015208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty