Provider Demographics
NPI:1811045453
Name:ADVANCED BREAST SURGERY LLC
Entity Type:Organization
Organization Name:ADVANCED BREAST SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-531-5200
Mailing Address - Street 1:257 MONMOUTH RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755
Mailing Address - Country:US
Mailing Address - Phone:732-531-5200
Mailing Address - Fax:732-531-5836
Practice Address - Street 1:257 MONMOUTH RD
Practice Address - Street 2:SUITE 2
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755
Practice Address - Country:US
Practice Address - Phone:732-531-5200
Practice Address - Fax:732-531-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07197700261QM2500X
NJMA55487261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ730143Medicare PIN
NJG22813Medicare UPIN