Organization
SR PLASTIC SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KANDICE KING (CREDENTIALING SPECIALIST)
(847) 228-3303
Entity
Organization
Contact information
Practice address
2 CORNWALL DR, UNIT B2, EAST BRUNSWICK, NJ 08816
(617) 233-9928
Mailing address
9 MOUNTHAVEN DR, LIVINGSTON, NJ 07039-2711
(617) 233-9928
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Enumeration date
01/23/2019
Last updated
09/20/2019
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