Healthcare Provider Details

I. General information

NPI: 1386831196
Provider Name (Legal Business Name): NEW REFLECTIONS PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W MAIN ST SUITE A
FREEHOLD NJ
07728-2579
US

IV. Provider business mailing address

1001 W MAIN ST SUITE A
FREEHOLD NJ
07728-2579
US

V. Phone/Fax

Practice location:
  • Phone: 732-354-3792
  • Fax:
Mailing address:
  • Phone: 732-354-3792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number25MA08305000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number25MA08305000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number25MA08305000
License Number StateNJ

VIII. Authorized Official

Name: NIKESH K PATEL
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 732-354-3792