Provider Demographics
NPI:1649357435
Name:NORTHERN JERSEY PLASTIC SURGERY CENTER, LLC
Entity type:Organization
Organization Name:NORTHERN JERSEY PLASTIC SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:EZRA
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-225-1811
Mailing Address - Street 1:25 ROCKWOOD PL STE 405
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4960
Mailing Address - Country:US
Mailing Address - Phone:201-225-1811
Mailing Address - Fax:201-616-7789
Practice Address - Street 1:25 ROCKWOOD PL STE 405
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4960
Practice Address - Country:US
Practice Address - Phone:201-225-1811
Practice Address - Fax:201-616-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08118000208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty