Provider Demographics
NPI:1386613834
Name:THE PLASTIC SURGERY CENTER, PA
Entity type:Organization
Organization Name:THE PLASTIC SURGERY CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-833-8720
Mailing Address - Street 1:535 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4206
Mailing Address - Country:US
Mailing Address - Phone:732-426-3420
Mailing Address - Fax:
Practice Address - Street 1:535 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-426-3420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000952OtherBCBS OF NJ
113905500OtherOFFICE OF WORKER'S COMP
A584143OtherOXFORD
31D1027971OtherCLIA
NJ8272000Medicaid
J21602OtherHEALTHNET
113905500OtherOFFICE OF WORKER'S COMP