Provider Demographics
NPI:1396700944
Name:WATTS PLASTIC SURGERY ASSOCIATION, P.C.
Entity type:Organization
Organization Name:WATTS PLASTIC SURGERY ASSOCIATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CASSELL
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-691-0200
Mailing Address - Street 1:1051 W SHERMAN AVE
Mailing Address - Street 2:BLDG. 2 STE A
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6931
Mailing Address - Country:US
Mailing Address - Phone:856-691-0200
Mailing Address - Fax:856-691-5984
Practice Address - Street 1:1051 W SHERMAN AVE
Practice Address - Street 2:BLDG. 2 STE A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6931
Practice Address - Country:US
Practice Address - Phone:856-691-0200
Practice Address - Fax:856-691-5984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075919Medicare ID - Type Unspecified