Provider Demographics
NPI:1063031862
Name:GANCHI PLASTIC SURGERY CENTER LLC
Entity Type:Organization
Organization Name:GANCHI PLASTIC SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PARHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:973-942-6600
Mailing Address - Street 1:246 HAMBURG TPKE STE 307
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2161
Mailing Address - Country:US
Mailing Address - Phone:973-942-6600
Mailing Address - Fax:973-595-5002
Practice Address - Street 1:246 HAMBURG TPKE STE 307
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2161
Practice Address - Country:US
Practice Address - Phone:973-942-6600
Practice Address - Fax:973-595-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical