Provider Demographics
NPI:1194764050
Name:VOLK, RANDALL WARREN (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:WARREN
Last Name:VOLK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 ZION RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1860
Mailing Address - Country:US
Mailing Address - Phone:609-272-0365
Mailing Address - Fax:609-272-0542
Practice Address - Street 1:1555 ZION RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1860
Practice Address - Country:US
Practice Address - Phone:609-272-0365
Practice Address - Fax:609-272-0542
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05428200208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ613033TYWMedicare PIN
NJE32438Medicare UPIN