Provider Demographics
NPI:1457822884
Name:COSMETIC SURGERY CENTER OF SOUTHERN NEW JERSEY LLC
Entity Type:Organization
Organization Name:COSMETIC SURGERY CENTER OF SOUTHERN NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SOROKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-797-0202
Mailing Address - Street 1:1734 MARLTON PIKE E
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2307
Mailing Address - Country:US
Mailing Address - Phone:856-797-0202
Mailing Address - Fax:
Practice Address - Street 1:1734 MARLTON PIKE E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2307
Practice Address - Country:US
Practice Address - Phone:856-797-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical