Healthcare Provider Details

I. General information

NPI: 1437199957
Provider Name (Legal Business Name): NEMEROFSKY PLASTIC SURGERY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 POCONO RD SUITE 103
DENVILLE NJ
07834-2901
US

IV. Provider business mailing address

PO BOX 1025
DENVILLE NJ
07834-0625
US

V. Phone/Fax

Practice location:
  • Phone: 973-784-1024
  • Fax: 973-710-0887
Mailing address:
  • Phone: 973-784-1024
  • Fax: 973-710-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA07215500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number25MA07215500
License Number StateNJ

VIII. Authorized Official

Name: DR. ROBERT BECKER NEMEROFSKY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 973-784-1024