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General NPI Number Information
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NPI Number | 1225137276
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Entity Type | Organization
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Legal Business Name | AVICENNA PLASTIC SURGERY, LLC
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 721 N BEERS ST SUITE 2B
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City | HOLMDEL
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State | NJ
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Zip | 07733-1518
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Country | US
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Telephone | 732-335-0335
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Fax |
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Provider Business Mailing Address
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Address Line | 721 N BEERS ST SUITE 2B
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City | HOLMDEL
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State | NJ
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Zip | 07733-1518
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Country | US
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Telephone | 732-335-0335
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. NEGIN NOORCHASHM GRIFFITH
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Credential | M.D.
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Telephone | 732-335-0335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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