Organization · Type 2 NPI
Northeast Breast Reconstruction LLC
Plastic and Reconstructive Surgery Physician · Southport, CT
NPI number
1255879748
Active
Practice location
21 Southport Terrace
Southport, CT 06890
Fax (718) 672-3280
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Plastic and Reconstructive Surgery Physician Primary | 2086S0122X | 25MA10021400 (NJ) |
Plastic and Reconstructive Surgery Physician: A surgeon who specializes in plastic and reconstructive surgery.
Other plastic and reconstructive surgery physician providers in Southport
About NPI 1255879748
Northeast Breast Reconstruction LLC's National Provider Identifier is 1255879748, issued on Feb 6, 2017. The primary taxonomy on file is Plastic and Reconstructive Surgery Physician (2086S0122X), and the practice location is in Southport, CT. The record was last updated on Feb 6, 2017.