NPIMap

Organization Active NPI

Northeast Plastic Surgery Center LLC

  • Plastic and Reconstructive Surgery Physician
  • Old Lyme, CT
National Provider Identifier
1932586682
Registry record updated May 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
045607 Issued in CT
Legal business name
NORTHEAST PLASTIC SURGERY CENTER LLC
Practice address
5-1 Davis Road West
Suite 3
Old Lyme, CT 06371
Phone
(917) 699-3727
Fax
(718) 672-4251
NPI assigned
May 1, 2015
Last updated
May 1, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2015

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

Authorized official

Name
Dr. Vinod Pathy, M.D.NPI 1922299098
Title
Owner
Phone
(917) 699-3727

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 and Reconstructive Surgery Physician 2086S0122X 045607 CT Primary

Addresses

Primary practice location

5-1 Davis Road West
Suite 3
Old Lyme, CT 06371

Mailing address

12 Halls Rd
Unit 878
Old Lyme, CT 06371-7000
Phone (917) 699-3727

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150805007262 CT Part B Supplier - Clinic/Group Practice 1456665371 Receives reassigned benefits from 4 practitioners
Practice locations: Old Lyme, CT

National Provider Directory

National Provider Directory

Locations

12 Halls Rd
Unit 878
Old Lyme, CT 06371

5 Davis Rd E
Old Lyme, CT 06371
Phone (860) 390-6000

Practitioners & affiliated clinicians

Practitioners 6

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": "1430438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430438400000",
    "number": "1932586682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 HALLS RD",
            "address_2": "UNIT 878",
            "city": "OLD LYME",
            "state": "CT",
            "postal_code": "063717000",
            "telephone_number": "917-699-3727",
            "fax_number": "718-672-4251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5-1 DAVIS ROAD WEST",
            "address_2": "SUITE 3",
            "city": "OLD LYME",
            "state": "CT",
            "postal_code": "06371",
            "telephone_number": "917-699-3727",
            "fax_number": "718-672-4251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST PLASTIC SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-01",
        "last_updated": "2015-05-01",
        "status": "A",
        "authorized_official_last_name": "PATHY",
        "authorized_official_first_name": "VINOD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-699-3727",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CT",
            "license": "045607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Old Lyme, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2015; 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.