Greater Boston Plastic Surgery & Luxe Aesthetics

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

257625 Issued in MA

Legal business name

GREATER BOSTON PLASTIC SURGERY & LUXE AESTHETICS

Practice address

10 Roseberry Dr
Boylston, MA 01505-2024

Phone

(413) 348-5192

NPI assigned

Jun 3, 2014

Organization subpart

No

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

Authorized official

Name

Mostafa Noury, MDNPI 1033379391

Title

Owner

Phone

(413) 348-5192

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Practitioners 2

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

• Mostafa Noury, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Northborough, MA
  • NPI 1033379391
  Medicare reassignment NPD Authorized official
• Jenna E Lin, NP-C

  • Family Nurse Practitioner
  • Northborough, MA
  • NPI 1225554710
  NPD (past)

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

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403568000000",
    "number": "1700299245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 ROSEBERRY DR",
            "city": "BOYLSTON",
            "state": "MA",
            "postal_code": "015052024",
            "telephone_number": "413-348-5192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 ROSEBERRY DR",
            "city": "BOYLSTON",
            "state": "MA",
            "postal_code": "015052024",
            "telephone_number": "413-348-5192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER BOSTON PLASTIC SURGERY & LUXE AESTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-03",
        "last_updated": "2014-06-24",
        "status": "A",
        "authorized_official_last_name": "NOURY",
        "authorized_official_first_name": "MOSTAFA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "413-348-5192",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "MA",
            "license": "257625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Dono, LICSW
• Jen Ellis, LMHC
• Ethos Rehabilitation Inc
• Martine Ferullo, PHARM D
• Dennis Goguen, LICSW
• Heather Guaragna, LMHC
• Stephanie A Hurley
• Jen Ellis LMHC LLC
• Jessica Rose Jolly, MA, LMHC
• Jimmy Kakouris, PT, DPT. CSCS

• Plastic Surgery Physician in Boylston, MA
• Providers in Boylston, MA by specialty
• Plastic Surgery Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.