Provider Demographics
NPI:1780306407
Name:COSMETIC SURGERY ASSOCIATES OF TEXAS
Entity type:Organization
Organization Name:COSMETIC SURGERY ASSOCIATES OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-985-7474
Mailing Address - Street 1:4100 W 15TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5826
Mailing Address - Country:US
Mailing Address - Phone:972-985-7474
Mailing Address - Fax:972-964-1372
Practice Address - Street 1:4100 W 15TH ST STE 106
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5826
Practice Address - Country:US
Practice Address - Phone:972-985-7474
Practice Address - Fax:972-964-1372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty