Healthcare Provider Details

I. General information

NPI: 1982456109
Provider Name (Legal Business Name): URBAN FACIAL PLASTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 STATE ROUTE 24 STE 3K
CHESTER NJ
07930-2910
US

IV. Provider business mailing address

385 STATE ROUTE 24 STE 3K
CHESTER NJ
07930-2910
US

V. Phone/Fax

Practice location:
  • Phone: 908-879-2222
  • Fax: 283-205-2239
Mailing address:
  • Phone: 908-879-2222
  • Fax: 283-205-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW J URBAN
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 908-879-2222