Healthcare Provider Details

I. General information

NPI: 1316727530
Provider Name (Legal Business Name): NOURI PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 ARCADIAN WAY STE C7
PARAMUS NJ
07652-1291
US

IV. Provider business mailing address

16 ARCADIAN WAY STE C7
PARAMUS NJ
07652-1291
US

V. Phone/Fax

Practice location:
  • Phone: 973-200-2050
  • Fax:
Mailing address:
  • Phone: 973-200-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. ANDREW M NOURI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 973-207-2575