Provider Demographics
NPI:1144539008
Name:LOOMIS PLASTIC SURGERY, PC
Entity type:Organization
Organization Name:LOOMIS PLASTIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:LOOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-342-6884
Mailing Address - Street 1:225 DOLSON AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6569
Mailing Address - Country:US
Mailing Address - Phone:845-342-6884
Mailing Address - Fax:845-342-4989
Practice Address - Street 1:225 DOLSON AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6569
Practice Address - Country:US
Practice Address - Phone:845-342-6884
Practice Address - Fax:845-342-4989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty