Provider Demographics
NPI:1831463256
Name:NUJUV PLASTIC SURGERY CENTER, P.A.
Entity Type:Organization
Organization Name:NUJUV PLASTIC SURGERY CENTER, P.A.
Other - Org Name:SUGAR LAND PLASTIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-846-4692
Mailing Address - Street 1:1321 UPLAND DR # 4951
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-4718
Mailing Address - Country:US
Mailing Address - Phone:281-846-4692
Mailing Address - Fax:888-809-7322
Practice Address - Street 1:1321 UPLAND DR # 4951
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-4718
Practice Address - Country:US
Practice Address - Phone:281-846-4692
Practice Address - Fax:888-809-7322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP11042086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB152325Medicare PIN