Provider Demographics
NPI:1508804493
Name:SAMRA PLASTIC AND RECONSTRUCTIVE SURGERY LLC
Entity Type:Organization
Organization Name:SAMRA PLASTIC AND RECONSTRUCTIVE SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BISKUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-739-2100
Mailing Address - Street 1:733 N BEERS ST
Mailing Address - Street 2:SUITE U1
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1528
Mailing Address - Country:US
Mailing Address - Phone:732-739-2100
Mailing Address - Fax:732-739-1002
Practice Address - Street 1:733 N BEERS ST
Practice Address - Street 2:SUITE U1
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1528
Practice Address - Country:US
Practice Address - Phone:732-739-2100
Practice Address - Fax:732-739-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03149800174400000X
NJ25MA07712600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty