Provider Demographics
NPI:1659442531
Name:CENTER FOR PLASTIC & RECONSTRUCTIVE SURGERY PA
Entity Type:Organization
Organization Name:CENTER FOR PLASTIC & RECONSTRUCTIVE SURGERY PA
Other - Org Name:PARKER CENTER FOR PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-967-1212
Mailing Address - Street 1:PO BOX 678688
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8688
Mailing Address - Country:US
Mailing Address - Phone:972-758-3595
Mailing Address - Fax:972-599-9604
Practice Address - Street 1:122 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4038
Practice Address - Country:US
Practice Address - Phone:201-967-1212
Practice Address - Fax:201-262-6270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ36477208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ512092Medicare PIN