Provider Demographics
NPI:1376975649
Name:MDSTYLE
Entity Type:Organization
Organization Name:MDSTYLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TADROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:201-408-5430
Mailing Address - Street 1:300 GRAND AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4398
Mailing Address - Country:US
Mailing Address - Phone:201-408-5430
Mailing Address - Fax:201-408-5437
Practice Address - Street 1:300 GRAND AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4398
Practice Address - Country:US
Practice Address - Phone:201-408-5430
Practice Address - Fax:201-408-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07910000207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty