Organization Active NPI

Delaware Plastic & Recon Surgery

  • Plastic Surgery Physician
  • Newark, DE
National Provider Identifier
1073653317
Registry record updated Aug 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
1990025547 Issued in DE
Legal business name
DELAWARE PLASTIC & RECON SURGERY
Practice address
One Centurian Dr
Suite 301
Newark, DE 19713-2127
Phone
(302) 994-8492
Fax
(302) 994-1155
NPI assigned
Feb 7, 2007
Last updated
Aug 8, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2008

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

Authorized official

Name
Abdollah Malek, M.D.NPI 1073669750
Title
President Owner
Phone
(302) 994-8492

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 1990025547 DE Primary

Addresses

Primary practice location

One Centurian Dr
Suite 301
Newark, DE 19713-2127

Mailing address

One Centurian Dr
Suite 301
Newark, DE 19713-2127
Phone (302) 994-8492

Other identifiers 1

IdentifierTypeStateIssuer
0000171202MedicaidDE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060330000060 DE Part B Supplier - Clinic/Group Practice 5890703094 Receives reassigned benefits from 2 practitioners
Practice locations: Lewes, DE; Newark, DE; Rehoboth Beach, DE

National Provider Directory

National Provider Directory

Locations

17644 Coastal Hwy
Unit G
Lewes, DE 19958
Phone (302) 645-7672

78C Omega Dr
Newark, DE 19713
Phone (302) 368-2883

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218153600000",
    "number": "1073653317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE CENTURIAN DR",
            "address_2": "SUITE 301",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197132127",
            "telephone_number": "302-994-8492",
            "fax_number": "302-994-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE CENTURIAN DR",
            "address_2": "SUITE 301",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197132127",
            "telephone_number": "302-994-8492",
            "fax_number": "302-994-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELAWARE PLASTIC & RECON SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2008-08-08",
        "status": "A",
        "authorized_official_last_name": "MALEK",
        "authorized_official_first_name": "ABDOLLAH",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "302-994-8492",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "DE",
            "license": "1990025547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000171202",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2008; 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.