NPIMap

Organization Active NPI

Daytona Plastic Surgery, P.L.

  • Clinic/Center
  • Port Orange, FL
National Provider Identifier
1073883971
Registry record updated Jan 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
ME 62606 Issued in FL
Legal business name
DAYTONA PLASTIC SURGERY, P.L.
Practice address
4606 S Clyde Morris Blvd
Suite 1 L
Port Orange, FL 32129-6404
Phone
(386) 756-9009
Fax
(386) 756-3006
NPI assigned
Jan 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2012

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

Authorized official

Name
Dr. Vijay J Moradia, M.B.,B.S.
Title
Managing Member
Phone
(386) 756-9009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X ME 62606 FL Primary

Addresses

Primary practice location

4606 S Clyde Morris Blvd
Suite 1 L
Port Orange, FL 32129-6404

Mailing address

4606 S Clyde Morris Blvd
Suite 1 L
Port Orange, FL 32129-6404
Phone (386) 756-9009

National Provider Directory

National Provider Directory

Locations

4606 Clyde Morris Blvd
Ste 1L
Port Orange, FL 32129
Phone (386) 756-9009

4606 Clyde Morris Blvd
#1
Port Orange, FL 32129
Phone (386) 756-9009

NPI Registry JSON

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

{
    "created_epoch": "1326067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326067200000",
    "number": "1073883971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4606 S CLYDE MORRIS BLVD",
            "address_2": "SUITE 1 L",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321296404",
            "telephone_number": "386-756-9009",
            "fax_number": "386-756-3006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4606 S CLYDE MORRIS BLVD",
            "address_2": "SUITE 1 L",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321296404",
            "telephone_number": "386-756-9009",
            "fax_number": "386-756-3006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAYTONA PLASTIC SURGERY, P.L.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-09",
        "last_updated": "2012-01-09",
        "status": "A",
        "authorized_official_last_name": "MORADIA",
        "authorized_official_first_name": "VIJAY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "386-756-9009",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.B.,B.S."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "ME 62606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.