Provider Demographics
NPI:1053441691
Name:PREMIER PLASTIC SURGERY CENTER OF NEW JERSEY LLC
Entity Type:Organization
Organization Name:PREMIER PLASTIC SURGERY CENTER OF NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GLATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-889-9300
Mailing Address - Street 1:310 MADISON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6967
Mailing Address - Country:US
Mailing Address - Phone:973-889-9300
Mailing Address - Fax:973-889-9400
Practice Address - Street 1:310 MADISON AVE STE 100
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6967
Practice Address - Country:US
Practice Address - Phone:973-889-9300
Practice Address - Fax:973-889-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07878300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty