Provider Demographics
NPI:1942496807
Name:VASISHT PLASTIC AND RECONSTRUCTIVE SURGERY, PC
Entity Type:Organization
Organization Name:VASISHT PLASTIC AND RECONSTRUCTIVE SURGERY, PC
Other - Org Name:SOUTH SHORE PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHUPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:VASISHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-784-2639
Mailing Address - Street 1:1307 WHITE HORSE RD
Mailing Address - Street 2:SUITE E501
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2176
Mailing Address - Country:US
Mailing Address - Phone:856-784-2639
Mailing Address - Fax:856-784-2659
Practice Address - Street 1:1307 WHITE HORSE RD
Practice Address - Street 2:SUITE E501
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2176
Practice Address - Country:US
Practice Address - Phone:856-784-2639
Practice Address - Fax:856-784-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71305208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093429Medicare PIN