Basic Information
| Provider Information | |||||||||
| NPI: | 1629468939 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 128 CENTRAL PARK SOUTH PHYSICIANS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 CENTRAL PARK S | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100191565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122652724 | ||||||||
| FaxNumber: | 2122652735 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 CENTRAL PARK S | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100191565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122652724 | ||||||||
| FaxNumber: | 2122652735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | CHIA | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2122652724 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 225031 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.