Provider Demographics
NPI:1598700700
Name:SOMERSET COSMETIC & RECONSTRUCTIVE SURGERY, LLC
Entity Type:Organization
Organization Name:SOMERSET COSMETIC & RECONSTRUCTIVE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-222-0070
Mailing Address - Street 1:31 MOUNTAIN BLVD.
Mailing Address - Street 2:BLDG T
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5648
Mailing Address - Country:US
Mailing Address - Phone:908-222-0070
Mailing Address - Fax:908-222-8027
Practice Address - Street 1:31 MOUNTAIN BLVD.
Practice Address - Street 2:BLDG T
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5648
Practice Address - Country:US
Practice Address - Phone:908-222-0070
Practice Address - Fax:908-222-8027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07555400208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJJ33130OtherHEALTHNET
NJMC01512F10OtherEMPIRE BC/BS
NJP3106486OtherOXFORD
NJP00166342OtherUNITED HEALTHCARE RR
NJ8219869OtherGHI
NJP00166342OtherUNITED HEALTHCARE RR