Provider Demographics
NPI:1477750503
Name:MONMOUTH PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:MONMOUTH PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-842-3737
Mailing Address - Street 1:PO BOX 8004
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8004
Mailing Address - Country:US
Mailing Address - Phone:732-842-3737
Mailing Address - Fax:732-842-3110
Practice Address - Street 1:264 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2003
Practice Address - Country:US
Practice Address - Phone:732-842-3737
Practice Address - Fax:732-842-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06219300208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG19636Medicare UPIN
NJ809152VA4Medicare ID - Type Unspecified