NPIMap

Organization Active NPI

Cosmetic and Reconstructive Surgery Associates of Connecticut, PC

  • Specialist
  • Shelton, CT
National Provider Identifier
1184021396
Registry record updated Dec 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
052225 Issued in CT
Legal business name
COSMETIC AND RECONSTRUCTIVE SURGERY ASSOCIATES OF CONNECTICUT, PC
Practice address
4 Corporate Dr
Suite 288
Shelton, CT 06484-6211
Phone
(203) 935-8160
Fax
(203) 935-8162
NPI assigned
Dec 3, 2014
Last updated
Dec 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2014

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

Authorized official

Name
Dr. Mark Manuel Melendez, MDNPI 1982861860
Title
President
Phone
(203) 935-8160

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
Specialist 174400000X 052225 CT Primary

Addresses

Primary practice location

4 Corporate Dr
Suite 288
Shelton, CT 06484-6211

Mailing address

4 Corporate Dr
Suite 288
Shelton, CT 06484-6211
Phone (203) 935-8160

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150312001210 CT Part B Supplier - Clinic/Group Practice 4587980479 Receives reassigned benefits from 1 practitioner
Practice locations: Greenwich, CT; Woodbridge, CT; Shelton, CT

National Provider Directory

National Provider Directory

Locations

4 Corporate Dr
Ste 288
Shelton, CT 06484
Phone (203) 935-8160

Practitioners & affiliated clinicians

Practitioners 4

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": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1184021396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 CORPORATE DR",
            "address_2": "SUITE 288",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064846211",
            "telephone_number": "203-935-8160",
            "fax_number": "203-935-8162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 CORPORATE DR",
            "address_2": "SUITE 288",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064846211",
            "telephone_number": "203-935-8160",
            "fax_number": "203-935-8162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSMETIC AND RECONSTRUCTIVE SURGERY ASSOCIATES OF CONNECTICUT, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "MELENDEZ",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "MANUEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-935-8160",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CT",
            "license": "052225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; 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.