1659442531 NPI number — CENTER FOR PLASTIC & RECONSTRUCTIVE SURGERY PA

Table of content: (NPI 1659442531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659442531 NPI number — CENTER FOR PLASTIC & RECONSTRUCTIVE SURGERY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR PLASTIC & RECONSTRUCTIVE SURGERY PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARKER CENTER FOR PLASTIC SURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659442531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 678688
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75267-8688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-758-3595
Provider Business Mailing Address Fax Number:
972-599-9604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 E RIDGEWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARAMUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07652-4038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-967-1212
Provider Business Practice Location Address Fax Number:
201-262-6270
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
201-967-1212

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  36477 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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