Organization
NEW JERSEY PLASTIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEE WILSON (OFFICE MANAGER)
(973) 509-2000
Entity
Organization
Contact information
Practice address
29 PARK ST, MONTCLAIR, NJ 07042-3407
(973) 509-2000
Mailing address
29 PARK ST, MONTCLAIR, NJ 07042-3407
(973) 509-2000
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164599262
—
NJ
05
—
1427342971
—
TX
05
—
1942563564
—
NJ
Enumeration date
09/23/2021
Last updated
09/28/2021
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