| Organization Name: | NORTHEAST PLASTIC SURGERY CENTER LLC |
| NPI Number: | 1932586682 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VINOD PATHY (OWNER) |
| Mailing Address: | 5-1 Davis Road West Suite 3 Old Lyme |
| State: | CT US |
| Postal Code: | 06371 |
| Phone Number: | 9176993727 |
| Fax Number: | 7186724251 |
| NPI Enumeration Date: | 05/01/2015 |
| NPI Last Update Date: | 05/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0122X |
| License Number: | 045607 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Plastic and Reconstructive Surgery |
| Taxonomy Definition: | A surgeon who specializes in plastic and reconstructive surgery. |