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General NPI Number Information
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NPI Number | 1851537864
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Entity Type | Organization
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Legal Business Name | NORTHERN NEW JERSEY PLASTIC SURGERY, LLC
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Dates
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Enumeration Date | 12/22/2008
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Last Update Date | 01/29/2009
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Provider Practice Location Address
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Address Line | 95 MADISON AVE SUITE 103
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6092
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Country | US
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Telephone | 973-270-0283
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 80
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City | LIBERTY CORNER
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State | NJ
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Zip | 07938-0080
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Country | US
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Telephone | 973-270-0283
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALBERT KO
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Credential | M.D.
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Telephone | 973-270-0283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25MA08443200
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License Number State | NJ
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