Provider Demographics
NPI:1336657121
Name:SOOD CENTER FOR PLASTIC SURGERY
Entity Type:Organization
Organization Name:SOOD CENTER FOR PLASTIC SURGERY
Other - Org Name:SOOD CENTER FOR PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER-DEPTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-479-2622
Mailing Address - Street 1:199 NEW RD STE 31
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2025
Mailing Address - Country:US
Mailing Address - Phone:609-904-5390
Mailing Address - Fax:
Practice Address - Street 1:199 NEW RD STE 31
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2025
Practice Address - Country:US
Practice Address - Phone:609-904-5390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOOD CENTER FOR PLASTIC SURGERY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-16
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09088300208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========8OtherSURGERY