Provider Demographics
NPI:1295179000
Name:EMMANUEL A. LAT, M.D., F.A.C.S., P.A.
Entity Type:Organization
Organization Name:EMMANUEL A. LAT, M.D., F.A.C.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-843-0700
Mailing Address - Street 1:17 ARCADIAN WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1245
Mailing Address - Country:US
Mailing Address - Phone:201-843-0700
Mailing Address - Fax:
Practice Address - Street 1:17 ARCADIAN WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1245
Practice Address - Country:US
Practice Address - Phone:201-843-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03883200208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54800Medicare UPIN