Healthcare Provider Details

I. General information

NPI: 1295179000
Provider Name (Legal Business Name): EMMANUEL A. LAT, M.D., F.A.C.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 ARCADIAN WAY SUITE 103
PARAMUS NJ
07652-1245
US

IV. Provider business mailing address

17 ARCADIAN WAY SUITE 103
PARAMUS NJ
07652-1245
US

V. Phone/Fax

Practice location:
  • Phone: 201-843-0700
  • Fax:
Mailing address:
  • Phone: 201-843-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number25MA03883200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. EMMANUEL LAT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-843-0700