Provider Demographics
NPI:1669631362
Name:ATLANTIC PLASTIC AND HAND SURGERY, PA
Entity Type:Organization
Organization Name:ATLANTIC PLASTIC AND HAND SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:RISIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-933-8788
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-0398
Mailing Address - Country:US
Mailing Address - Phone:732-933-8788
Mailing Address - Fax:732-933-1536
Practice Address - Street 1:2 ROUTE 27
Practice Address - Street 2:SUITE 508
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3961
Practice Address - Country:US
Practice Address - Phone:732-933-8788
Practice Address - Fax:732-933-1536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA076136002086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097628Medicare PIN