Organization
PLASTICG LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB GERZENSHTEIN MD (OWNER)
(813) 616-3338
Entity
Organization
Contact information
Practice address
4429 FLORIDA NATIONAL DR, LAKELAND, FL 33813-1516
(863) 647-2200
(888) 854-1888
Mailing address
4429 FLORIDA NATIONAL DR, LAKELAND, FL 33813-1516
(863) 647-2200
(888) 854-1888
Taxonomy
Speciality
Code
Description
License number
State
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
—
—
208200000X
Plastic Surgery Physician
—
—
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
—
—
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Enumeration date
04/03/2011
Last updated
09/22/2020
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