Provider Demographics
NPI:1053426502
Name:ASSOCIATES IN PLASTIC SURGERY, INC.
Entity type:Organization
Organization Name:ASSOCIATES IN PLASTIC SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MD,FACS
Authorized Official - Phone:757-491-3535
Mailing Address - Street 1:1037 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3037
Mailing Address - Country:US
Mailing Address - Phone:757-491-3535
Mailing Address - Fax:757-422-4750
Practice Address - Street 1:1037 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3037
Practice Address - Country:US
Practice Address - Phone:757-491-3535
Practice Address - Fax:757-422-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTAX ID NUMBER
VA=========OtherTAX ID NUMBER