Provider Demographics
NPI:1801978184
Name:MOHAWK VALLEY PLASTIC & RECONSTRUCTIVE SURGERY PLLC
Entity type:Organization
Organization Name:MOHAWK VALLEY PLASTIC & RECONSTRUCTIVE SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ORLANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-266-0407
Mailing Address - Street 1:4401 MIDDLE SETTLEMENT RD STE 102
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-5332
Mailing Address - Country:US
Mailing Address - Phone:315-735-4996
Mailing Address - Fax:315-735-7066
Practice Address - Street 1:4401 MIDDLE SETTLEMENT RD STE 102
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5332
Practice Address - Country:US
Practice Address - Phone:315-735-4996
Practice Address - Fax:315-735-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199751208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02636208Medicaid
NYBA0467Medicare PIN