Healthcare Provider Details

I. General information

NPI: 1154317345
Provider Name (Legal Business Name): VOLK CENTER FOR COSMETIC & PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 ZION RD STE 103
NORTHFIELD NJ
08225-1860
US

IV. Provider business mailing address

1555 ZION RD STE 103
NORTHFIELD NJ
08225-1860
US

V. Phone/Fax

Practice location:
  • Phone: 609-272-0365
  • Fax: 609-272-0542
Mailing address:
  • Phone: 609-272-0365
  • Fax: 609-272-0542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number25MA05428200
License Number StateNJ

VIII. Authorized Official

Name: DR. RANDALL WARREN VOLK
Title or Position: OWNER
Credential: MD
Phone: 609-272-0365