Provider Demographics
NPI:1801200472
Name:AYDIN PLASTIC SURGERY PA
Entity Type:Organization
Organization Name:AYDIN PLASTIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEBIL
Authorized Official - Middle Name:BILL
Authorized Official - Last Name:AYDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-265-1300
Mailing Address - Street 1:140 N ROUTE 17
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2809
Mailing Address - Country:US
Mailing Address - Phone:201-345-0100
Mailing Address - Fax:201-820-0333
Practice Address - Street 1:140 N RTE 17 STE 200
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2829
Practice Address - Country:US
Practice Address - Phone:201-345-0100
Practice Address - Fax:201-820-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08725200208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073776589OtherINDIVIDUAL NPI