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NORTHEAST BREAST RECONSTRUCTION LLC
NPI 1255879748
Surgery - Plastic and Reconstructive Surgery in Southport, CT

Active since February 06, 2017
21 SOUTHPORT TERRACE, SOUTHPORT, CT 06890(718) 672-2824(718) 672-3280 Get Directions Write a Review

NPPES record last updated: February 6, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Northeast Breast Reconstruction Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHEAST BREAST RECONSTRUCTION LLC (NPI 1255879748) is a healthcare organization registered as a plastic and reconstructive surgery in Southport, Connecticut and active in the NPI registry since February 2017. The organization lists Shareef Jandali, Owner, as its authorized official.

NPPES Registry Identity

NPI1255879748
Entity TypeOrganization
Primary Taxonomy2086S0122X
Legal Business NameNORTHEAST BREAST RECONSTRUCTION LLC
Location Address21 SOUTHPORT TERRACESouthport, CT 06890
Mailing Address21 Southport TerraceSouthport, CT 06890 · (718) 672-2824 · Fax (718) 672-3280
Phone(718) 672-2824
Fax(718) 672-3280
Organization SubpartNo
Authorized OfficialShareef JandaliOwner · (718) 672-2824
Enumeration DateFebruary 6, 2017
✔ NPI 1255879748 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0122X
License✔ Licensed in NJ · 25MA10021400
Definition
A surgeon who specializes in plastic and reconstructive surgery.
21 SOUTHPORT TERRACE, Southport, CT 06890
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northeast Breast Reconstruction LLC's NPI number?

The NPI number for Northeast Breast Reconstruction LLC is 1255879748. It was assigned to this organization in the NPPES registry on February 6, 2017.

Where is Northeast Breast Reconstruction LLC located?

Northeast Breast Reconstruction LLC is located at 21 Southport Terrace, Southport, CT 06890. The listed phone number is (718) 672-2824.

What is Northeast Breast Reconstruction LLC's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

When was this NPI record last updated?

The NPPES record for Northeast Breast Reconstruction LLC was last updated on February 6, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.