Healthcare Provider Details

I. General information

NPI: 1740219823
Provider Name (Legal Business Name): PARKER CENTER FOR PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E RIDGEWOOD AVE
PARAMUS NJ
07652-4038
US

IV. Provider business mailing address

27 EDITH ST
OLD TAPPAN NJ
07675-7105
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-1212
  • Fax: 201-262-6270
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA36477
License Number StateNJ

VIII. Authorized Official

Name: DR. PAUL M PARKER
Title or Position: OWNER
Credential: M.D.
Phone: 201-967-1212