NPIMap

Organization Active NPI

Bastidas Plastic Surgery, PC

  • Plastic Surgery Physician
  • Paterson, NJ
National Provider Identifier
1053724674
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
25MA07689900 Issued in NJ
Legal business name
BASTIDAS PLASTIC SURGERY, PC
Practice address
599 Broadway
Unit 1a
Paterson, NJ 07514-1969
Phone
(610) 442-0992
NPI assigned
Jun 11, 2014
Last updated
Jul 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Authorized official

Name
Dr. Jaime A Bastidas, M.D.NPI 1992807705
Title
President
Phone
(212) 734-6621

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 25MA07689900 NJ Primary

Addresses

Primary practice location

599 Broadway
Unit 1a
Paterson, NJ 07514-1969

Mailing address

5388 Rolling Hills Rd
Saylorsburg, PA 18353-8054
Phone (610) 442-0992

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231028000389 NJ Part B Supplier - Clinic/Group Practice 9234357328 Receives reassigned benefits from 20 practitioners
Practice locations: Phillipsburg, NJ; Toms River, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1053724674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5388 ROLLING HILLS RD",
            "city": "SAYLORSBURG",
            "state": "PA",
            "postal_code": "183538054",
            "telephone_number": "610-442-0992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "599 BROADWAY",
            "address_2": "UNIT 1A",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075141969",
            "telephone_number": "610-442-0992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASTIDAS PLASTIC SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-11",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A",
        "authorized_official_last_name": "BASTIDAS",
        "authorized_official_first_name": "JAIME",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-734-6621",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NJ",
            "license": "25MA07689900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paterson, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; 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.