Provider Demographics
NPI:1649497892
Name:LAWRENCEVILLE PLASTIC SURGERY PC
Entity type:Organization
Organization Name:LAWRENCEVILLE PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SMOTRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-896-2525
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BLDG 5
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2201
Mailing Address - Country:US
Mailing Address - Phone:609-896-2525
Mailing Address - Fax:609-896-2639
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BLDG 5
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-896-2525
Practice Address - Fax:609-896-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0534492086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC68682Medicare UPIN
NJ088046Medicare PIN