Provider Demographics
NPI:1619122652
Name:ALLURE PLASTIC SURGERY ENT PC
Entity type:Organization
Organization Name:ALLURE PLASTIC SURGERY ENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-477-2020
Mailing Address - Street 1:1424 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1500
Mailing Address - Country:US
Mailing Address - Phone:718-477-2020
Mailing Address - Fax:718-477-2031
Practice Address - Street 1:1424 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1500
Practice Address - Country:US
Practice Address - Phone:718-477-2020
Practice Address - Fax:718-477-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 208200000X
NY158614-1207YS0123X
NY220593-12086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000793Medicare PIN