Island Cosmetic and Reconstructive Surgery PLLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

124739 Issued in NY

Legal business name

ISLAND COSMETIC AND RECONSTRUCTIVE SURGERY PLLC

Practice address

190 E Jericho Tpke
Mineola, NY 11501-2033

Phone

(516) 977-9922

Fax

(516) 977-9926

NPI assigned

Apr 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Shannon Boyd

Title

Office Manager

Phone

(516) 534-2121

Specialties & licenses 1

Addresses

Other names 2

• Island Plastic Surgery Doing business as
• Island Plastic Surgery Aesthetic & Wellness Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Micheline Goulart, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Roslyn, NY
  • NPI 1568840940
  Medicare reassignment NPD
• Andrea Johnnidis-Klein, PA

  • Surgical Physician Assistant
  • Mineola, NY
  • NPI 1962559336
  NPD (past)
• Alyssa Vanderhoef, FNP

  • Family Nurse Practitioner
  • Mineola, NY
  • NPI 1982427332
  NPD (past)
• Elizabeth Roya Emami, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Medford, OR
  • NPI 1780604207

  Plastic Surgery

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769990400000",
    "number": "1013038702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E JERICHO TPKE",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115012033",
            "telephone_number": "516-977-9922",
            "fax_number": "516-977-9926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 E JERICHO TPKE",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115012033",
            "telephone_number": "516-977-9922",
            "fax_number": "516-977-9926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND COSMETIC AND RECONSTRUCTIVE SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2026-02-02",
        "certification_date": "2026-02-02",
        "status": "A",
        "authorized_official_last_name": "BOYD",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "516-534-2121",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "NY",
            "license": "124739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Island Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Island Plastic Surgery Aesthetic & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ira J Spector MD & Steven Aklein MDPC
• Tyesha Deseree Irving, MD
• Teofilita Isaacson, M.D.
• Fatin Ishraq, MD
• Nowshin Islam, MD
• Island Interventional Pain Management PLLC
• Island Therapy Fitness Center, LLC
• Island Wide Medical Associates, PC
• Eugene Israilov, PT, DPT
• Tova Fischer Isseroff, M.D.

• Plastic Surgery Physician in Mineola, NY
• Providers in Mineola, NY by specialty
• Plastic Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.