Healthcare Provider Details

I. General information

NPI: 1598589491
Provider Name (Legal Business Name): INSTITUTE FOR ADVANCED RECONSTRUCTION (OH), LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 THOMAS LN STE 1A
COLUMBUS OH
43214-1419
US

IV. Provider business mailing address

200 SCHULZ DR STE 2
RED BANK NJ
07701-6745
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-0970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANN MAGNER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 732-333-8720