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General NPI Number Information
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NPI Number | 1598700700
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Entity Type | Organization
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Legal Business Name | SOMERSET COSMETIC & RECONSTRUCTIVE SURGERY, LLC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 31 MOUNTAIN BLVD. BLDG T
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City | WARREN
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State | NJ
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Zip | 07059-5648
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Country | US
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Telephone | 908-222-0070
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Fax | 908-222-8027
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Provider Business Mailing Address
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Address Line | 31 MOUNTAIN BLVD. BLDG T
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City | WARREN
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State | NJ
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Zip | 07059-5648
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Country | US
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Telephone | 908-222-0070
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Fax | 908-222-8027
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW A CLOTT
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Credential | M.D.
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Telephone | 908-222-0070
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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 | 25MA07555400
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License Number State | NJ
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