Healthcare Provider Details

I. General information

NPI: 1730015546
Provider Name (Legal Business Name): PLASTIC, RECONSTRUCTIVE, & INNOVATIVE MEDICAL AESTHETICS OF NEW JERSEY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MAIN ST STE 3
BEDMINSTER NJ
07921-2689
US

IV. Provider business mailing address

350 MAIN ST STE 3
BEDMINSTER NJ
07921-2689
US

V. Phone/Fax

Practice location:
  • Phone: 908-907-4364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DEREK WOLOSZYN
Title or Position: OWNER
Credential: MD
Phone: 908-907-4364