Healthcare Provider Details

I. General information

NPI: 1942496807
Provider Name (Legal Business Name): VASISHT PLASTIC AND RECONSTRUCTIVE SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 WHITE HORSE RD SUITE E501
VOORHEES NJ
08043-2176
US

IV. Provider business mailing address

1307 WHITE HORSE RD SUITE E501
VOORHEES NJ
08043-2176
US

V. Phone/Fax

Practice location:
  • Phone: 856-784-2639
  • Fax: 856-784-2659
Mailing address:
  • Phone: 856-784-2639
  • Fax: 856-784-2659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMA71305
License Number StateNJ

VIII. Authorized Official

Name: DR. BHUPESH VASISHT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 856-784-2639