Provider Demographics
NPI:1265643209
Name:BULAN PLASTIC SURGERY PA
Entity Type:Organization
Organization Name:BULAN PLASTIC SURGERY PA
Other - Org Name:BULANPLASTICSURGERY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BULAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-467-9744
Mailing Address - Street 1:75 MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1322
Mailing Address - Country:US
Mailing Address - Phone:973-467-9744
Mailing Address - Fax:973-467-7512
Practice Address - Street 1:75 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1322
Practice Address - Country:US
Practice Address - Phone:973-467-9744
Practice Address - Fax:973-467-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA026961174400000X
NJ25MA07379300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty