Healthcare Provider Details

I. General information

NPI: 1013707769
Provider Name (Legal Business Name): TC PLASTIC SURGERY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROCKWOOD PL STE 405
ENGLEWOOD NJ
07631-4960
US

IV. Provider business mailing address

25 ROCKWOOD PL STE 405
ENGLEWOOD NJ
07631-4960
US

V. Phone/Fax

Practice location:
  • Phone: 201-225-1811
  • Fax: 201-616-7789
Mailing address:
  • Phone: 201-225-1811
  • Fax: 201-616-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TROY CALLAHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 201-225-1811