Provider Demographics
NPI:1053600247
Name:PLASTIC SURGERY SPECIALIST OF NEW JERSEY P C
Entity type:Organization
Organization Name:PLASTIC SURGERY SPECIALIST OF NEW JERSEY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FERRARO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:201-294-2908
Mailing Address - Street 1:75 N MAPLE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3247
Mailing Address - Country:US
Mailing Address - Phone:201-664-8000
Mailing Address - Fax:908-953-0550
Practice Address - Street 1:75 N MAPLE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3247
Practice Address - Country:US
Practice Address - Phone:201-664-8000
Practice Address - Fax:908-953-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05457100208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ951515OtherMEDICARE PTAN
NJG46359Medicare UPIN