Basic Information
| Provider Information | |||||||||
| NPI: | 1487192233 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NSPC PLASTICS | ||||||||
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| OtherOrganizationName: | GREAT NECK NEUROLOGICAL SURGERY P.C. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MERRICK RD | ||||||||
| Address2: | SUITE 128 W | ||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115704800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164423461 | ||||||||
| FaxNumber: | 5164423462 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MERRICK RD | ||||||||
| Address2: | SUITE 128 W | ||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115704800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164423461 | ||||||||
| FaxNumber: | 5164423462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2017 | ||||||||
| LastUpdateDate: | 02/01/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | THOMAS-JACKSON | ||||||||
| AuthorizedOfficialFirstName: | ZORINA | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5164423461 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEUROLOGICAL SURGERY P.C. | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CPC,CPC-I | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 254993 | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery | 208200000X | 278637 | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.