1316019300 NPI number — PLASTIC SURGERY CENTER OF NEW

Table of content: DR. PHILIP GAIL ITKIN (NPI 1447322490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316019300 NPI number — PLASTIC SURGERY CENTER OF NEW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLASTIC SURGERY CENTER OF NEW
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:
Provider Other Organization Name Type Code:
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:
1316019300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 MADISON AVE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07960-7360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-540-9546
Provider Business Mailing Address Fax Number:
973-540-0344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07960-7360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-540-9546
Provider Business Practice Location Address Fax Number:
973-540-0344
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PYO
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-540-9546

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  25MA06570500 , 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)

  • Identifier: 023387 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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