Provider Demographics
NPI:1154317345
Name:VOLK CENTER FOR COSMETIC & PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:VOLK CENTER FOR COSMETIC & PLASTIC SURGERY LLC
Other - Org Name:ADVANTAGE COSMETIC SURGERY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:VOLK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-272-0365
Mailing Address - Street 1:1555 ZION RD
Mailing Address - Street 2:STE 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:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05428200208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088763Medicare PIN