Facial Plastic, Reconstructive & Laser Surgery, PLLC

Primary specialty

Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X

License

211519 Issued in NY

Legal business name

FACIAL PLASTIC, RECONSTRUCTIVE & LASER SURGERY, PLLC

Practice address

82 N Water St
Poughkeepsie, NY 12601-1721

Phone

(845) 454-8025

Fax

(845) 454-8026

NPI assigned

Mar 4, 2007

Last updated

Oct 1, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Manoj Timothy Abraham, M.D., F.A.C.S.NPI 1679682892

Title

Owner

Phone

(845) 454-8025

Specialties & licenses 2

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

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.

• Manoj Timothy Abraham, M.D., F.A.C.S.

  • Facial Plastic Surgery Physician
  • Poughkeepsie, NY
  • NPI 1679682892

  Otolaryngology

  Medicare reassignment Care Compare group NPD Authorized official
• Bruce Moskowitz, M.D.

  • Ophthalmology Physician
  • New York, NY
  • NPI 1982644910
  Medicare reassignment Care Compare group NPD
• Ryan Young, P. A.

  • Otolaryngology Physician
  • Poughkeepsie, NY
  • NPI 1720198047
  Medicare reassignment
• Hal N Buch, MD

  • Gastroenterology Physician
  • Kingston, NY
  • NPI 1780649574
  NPD (past)
• Marisa G. Flanagan, FNP-BC

  • Nurse Practitioner
  • Kingston, NY
  • NPI 1598702227
  NPD (past)
• Nicholas Charles Golden, M.D.

  • Gastroenterology Physician
  • Vero Beach, FL
  • NPI 1619978343
  NPD (past)
• Joann Habermann, MD

  • Anatomic Pathology Physician
  • Newark, NJ
  • NPI 1831286921
  NPD (past)
• Miroslav Rade Radevic, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Eatontown, NJ
  • NPI 1275779894
  NPD (past)

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

{
    "created_epoch": "1172966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222819200000",
    "number": "1730218074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 N WATER ST",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126011721",
            "telephone_number": "845-454-8025",
            "fax_number": "845-454-8026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 N WATER ST",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126011721",
            "telephone_number": "845-454-8025",
            "fax_number": "845-454-8026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACIAL PLASTIC, RECONSTRUCTIVE & LASER SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-04",
        "last_updated": "2008-10-01",
        "status": "A",
        "authorized_official_last_name": "ABRAHAM",
        "authorized_official_first_name": "MANOJ",
        "authorized_official_middle_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-454-8025",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., F.A.C.S."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "211519",
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "NY",
            "license": "211519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO POS",
            "identifier": "7539468",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "3289877",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "7M7521",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNOW",
            "identifier": "000415207001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP ENT",
            "identifier": "362957",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP PLASTIC",
            "identifier": "363203",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD LIBERTY, FREEDOM",
            "identifier": "P3063915",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "10074336",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edgardo Fabery Zeno, CRNA
• Kasie Fabiano, LPN
• Steven Fabrizio
• Victoria Wolfe Facchin, CCC-SLP
• Kerrie Facci
• Keith Timmermann Fadelici, L.C.S.W.
• Kathryn Ann Fagan
• Nicole Fagan, LCSW
• Muhammad Amirul Islam Fahim, BCBA
• Petagay P. Fairclough

• Facial Plastic Surgery Physician in Poughkeepsie, NY
• Providers in Poughkeepsie, NY by specialty
• Facial Plastic Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 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.