Provider Demographics
NPI:1811992860
Name:PLASTIC & COSMETIC SURGICAL GROUP OF NEW JERSEY, P.C.
Entity type:Organization
Organization Name:PLASTIC & COSMETIC SURGICAL GROUP OF NEW JERSEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. ASST.
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH (DEBBIE)
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANZILOTTA CIARLANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-256-7705
Mailing Address - Street 1:1007 MANTUA PIKE, SUITE B
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3963
Mailing Address - Country:US
Mailing Address - Phone:856-256-7705
Mailing Address - Fax:856-256-7709
Practice Address - Street 1:1007 MANTUA PIKE, SUITE B
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3963
Practice Address - Country:US
Practice Address - Phone:856-256-7705
Practice Address - Fax:856-256-7709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0100919424208200000X
208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0033464Medicaid
PA079874Medicare PIN
NJ081318Medicare ID - Type Unspecified