Northeast Breast Reconstruction LLC
Surgery, Plastic and Reconstructive Surgery in Southport, Connecticut
1255879748- Practice location
- 21 Southport Terrace, Southport, CT 06890
- Phone
- 718-672-2824
- Fax
- 718-672-3280
- Last updated
- February 6, 2017
Northeast Breast Reconstruction LLC is a healthcare organization based in Southport, CT. Northeast Breast Reconstruction LLC practices in Southport, CT. The NPI Number for Northeast Breast Reconstruction LLC is 1255879748 and holds a License No. 25MA10021400 (NJ). The current practice location address for Northeast Breast Reconstruction LLC is 21 Southport Terrace, Southport, CT 06890 and can be reached out via phone at 718-672-2824 and via fax at 718-672-3280.
Provider Profile Details
- NPI Number
- 1255879748
- Provider Name
- Northeast Breast Reconstruction LLC
- Provider Entity Type
- Organization
- Address
- 21 Southport Terrace, Southport, CT 06890
- Phone Number
- 718-672-2824
- Fax Number
- 718-672-3280
- Primary Taxonomy
- Surgery, Plastic and Reconstructive Surgery · 2086S0122X
- Organization Subpart
- No
- Authorized Official
- Dr. Shareef Jandali, MD · Owner · 718-672-2824
- Provider Enumeration Date
- February 6, 2017
- Last Update Date
- February 6, 2017
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 21 Southport Terrace
Southport, CT 06890 - City
- Southport
- State
- Connecticut
- Zip
- 06890
- Phone Number
- 718-672-2824
- Fax Number
- 718-672-3280
Provider Business Mailing Address Details
- Address
- 21 Southport Terrace
Southport, CT 06890 - City
- Southport
- State
- CT
- Zip
- 06890
- Phone Number
- 718-672-2824
- Fax Number
- 718-672-3280
License Information
- License Number
- 25MA10021400
- License State
- NJ
- Taxonomy
- Surgery, Plastic and Reconstructive Surgery · 2086S0122X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Surgery, Plastic and Reconstructive Surgery providers near Southport, CT
View all Surgery, Plastic and Reconstructive Surgery providers in Southport →- Connecticut Plastic Surgery Group, LLCSurgery, Plastic and Reconstructive Surgery · NPI 1689812885
- Mrs. Margaret R YatesPhysical Therapist · NPI 1538348404
- Delaina Merkert, DNP, APRN, FNP-BCNurse Practitioner, Family · NPI 1942934245
- Progressive Care Medical Group Of CT, PLLCNurse Practitioner · NPI 1679107940
- Atharva HegishtePhysical Therapist · NPI 1053222745
- Regina Dowd, RNRegistered Nurse, Case Management · NPI 1821909623
Frequently Asked Questions
What is the NPI number of Northeast Breast Reconstruction LLC?
The NPI number of Northeast Breast Reconstruction LLC is 1255879748. It was assigned on February 6, 2017 and is currently active in the NPPES registry.
What is the specialty of Northeast Breast Reconstruction LLC?
Northeast Breast Reconstruction LLC is registered under the primary taxonomy Surgery, Plastic and Reconstructive Surgery (code 2086S0122X), licensed in NJ under license number 25MA10021400.
Where does Northeast Breast Reconstruction LLC practice?
The practice location is 21 Southport Terrace, Southport, CT 06890. The office can be reached at 718-672-2824 (phone) or 718-672-3280 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1255879748 directly on the NPPES registry website.