Provider Demographics
NPI:1366864498
Name:SCULPT SURGICAL, LLC
Entity Type:Organization
Organization Name:SCULPT SURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC AND RECONSTRUCTION SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:MEHUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-577-6050
Mailing Address - Street 1:53 WHITEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 MADISON AVE STE 120
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7360
Practice Address - Country:US
Practice Address - Phone:973-577-6050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08778700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ208269Medicare PIN