NORTHEAST BREAST RECONSTRUCTION LLC


Address: 21 Southport Terrace, Southport, CT 06890
Phone: 7186722824

NORTHEAST BREAST RECONSTRUCTION LLC (NPI# 1255879748) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1255879748
Entity Type Organization
Organization Name NORTHEAST BREAST RECONSTRUCTION LLC
Practice Address 21 Southport Terrace
Southport
CT 06890
Practice Telephone 7186722824
Practice Fax Number 7186723280
Mailing Telephone 7186722824
Mailing Fax Number 7186723280
Enumeration Date 2017-02-06
Last Update Date 2017-02-06
Authorized Official Name DR. SHAREEF JANDALI (OWNER)
Authorized Official Telephone 7186722824
Authorized Official Credential M.D.
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2086S0122X Surgery
Specialization: Plastic and Reconstructive Surgery
25MA10021400 NJ Allopathic & Osteopathic Physicians

Office Location

Street Address 21 SOUTHPORT TERRACE
City SOUTHPORT
State CT
Zip Code 06890

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1821500703 Abby Hill Smith Audiologist 2600 Post Rd Ste 2, Southport, CT 06890 2017-10-31
1487108908 Discovery Practice Management, Inc. Psychiatric Residential Treatment Facility 3530 Post Rd Ste 306, Southport, CT 06890 2016-08-12
1023469343 Alexandra Kosma Behavioral Analyst 1080 Mill Hill Ter, Southport, CT 06890 2016-06-28
1801126552 Sabita Kanhai Massage Therapist 3519 Post Road, Southport, CT 06890 2009-12-31
1083689962 Ben Duncan Ramaley Specialist 2600 Post Road, Suite 1l, Southport, CT 06890 2006-02-22
1689160145 Aaron Nichols Optometrist 2600 Post Rd, Southport, CT 06890 2018-07-09
1346594116 Sharon Renee Mccormick Marriage & Family Therapist 49 John Street, New Learning Therapy Center, Southport, CT 06890 2012-11-01
1841558897 Olga Marsillio Nurse Anesthetist, Certified Registered Norwalk Hospital, 34 Maple Street, Norwalk, CT 06890 2012-04-27
1073673992 Carl F Gruning Optometrist 2600 Post Rd, Southport, CT 06890 2006-12-11
1447319405 Charles Lee Mellinger Optometrist 2600 Post Rd, Southport, CT 06890 2006-12-06
Find all providers in zip 06890

Taxonomy Information

Taxonomy Code 2086S0122X
Grouping Allopathic & Osteopathic Physicians
Classification Surgery
Specialization Plastic and Reconstructive Surgery

Taxonomy Definition

A surgeon who specializes in plastic and reconstructive surgery.
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery.

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1932586682 Northeast Plastic Surgery Center LLC Surgery 5-1 Davis Road West, Suite 3, Old Lyme, CT 06371 2015-05-01
1205168499 Vinod V Pathy Md LLC Surgery 1525 Boston Post Rd, Westbrook, CT 06498-2044 2010-02-12
1568609121 Stacey Lauren June Surgery 107 Newtown Road Suite 2c, Danbury, CT 06810 2009-01-19
1982861860 Mark Manuel Melendez Surgery 4 Corporate Dr Ste 288, Shelton, CT 06484-6240 2008-05-19
1275602146 Andrew Nelson Kornstein Surgery 539 Danbury Rd, Wilton, CT 06897-2216 2006-11-07
1831287275 Sergio D. Francescon Surgery 540 S. Broad Street, Suite 3c, Meriden, CT 06450-6600 2006-10-11
1578583282 Stephan Ariyan Surgery 60 Temple St Ste 7c, New Haven, CT 06510-2716 2006-07-19
1093795387 Colleen J Jambor Surgery 33 Dale Road, Ste 1, Avon, CT 06001 2006-01-20
1053303818 John F Reilly Surgery 2 Ivy Brook Rd, Suite 105, Shelton, CT 06484-6416 2005-08-18
1922515006 The Plastic and Reconstructive Surgery Group, PC Surgery 2 Greenwich Office Park Ste 210, Greenwich, CT 06831-5155 2018-01-10
Find all providers with the same taxonomy

Competitor

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City SOUTHPORT
Zip Code 06890

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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