Provider Demographics
NPI:1376592196
Name:RIVERSIDE PLASTIC SURGERY & SINUS CENTER LLC
Entity Type:Organization
Organization Name:RIVERSIDE PLASTIC SURGERY & SINUS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINDYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-747-5300
Mailing Address - Street 1:70 E FRONT ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1851
Mailing Address - Country:US
Mailing Address - Phone:732-747-5300
Mailing Address - Fax:732-747-9922
Practice Address - Street 1:70 E FRONT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1851
Practice Address - Country:US
Practice Address - Phone:732-747-5300
Practice Address - Fax:732-747-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311145Medicare ID - Type Unspecified