Provider Demographics
NPI:1548399082
Name:IMAGE PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:IMAGE PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:MOSKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-788-7912
Mailing Address - Street 1:140 ROUTE 17 NORTH
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-225-1101
Mailing Address - Fax:201-225-1106
Practice Address - Street 1:140 ROUTE 17 NORTH
Practice Address - Street 2:SUITE 105
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-225-1101
Practice Address - Fax:201-225-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05943000208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0027740Medicaid
NJ0027740Medicaid
NJ087077Medicare PIN