Healthcare Provider Details

I. General information

NPI: 1922165901
Provider Name (Legal Business Name): CENTER FOR COSMETIC AND RECONSTRUCTIVE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SEARS DR
PARAMUS NJ
07652-3515
US

IV. Provider business mailing address

1 SEARS DR
PARAMUS NJ
07652-3515
US

V. Phone/Fax

Practice location:
  • Phone: 201-261-7550
  • Fax: 201-261-7515
Mailing address:
  • Phone: 201-261-7550
  • Fax: 201-261-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JANEL DIMARIA
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 732-383-4155