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General NPI Number Information
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NPI Number | 1053441691
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Entity Type | Organization
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Legal Business Name | PREMIER PLASTIC SURGERY CENTER OF NEW JERSEY LLC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 310 MADISON AVE STE 100
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6967
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Country | US
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Telephone | 973-889-9300
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Fax | 973-889-9400
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Provider Business Mailing Address
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Address Line | 310 MADISON AVE STE 100
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6967
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Country | US
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Telephone | 973-889-9300
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Fax | 973-889-9400
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BRIAN S GLATT
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Credential | M.D.
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Telephone | 973-889-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA07878300
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License Number State | NJ
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