De Omilia Plastic Surgery PC

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

25MA07315300 Issued in NJ

Legal business name

DE OMILIA PLASTIC SURGERY PC

Practice address

96 South Finley Ave
Basking Ridge, NJ 07920

Phone

(908) 221-1136

Fax

(908) 221-0482

NPI assigned

Sep 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David Z Evdokimow, MD

Title

Owner

Phone

(908) 221-1136

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary-Laura Klesaris, MD

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1477512556
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207180800000",
    "number": "1164618435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 SOUTH FINLEY AVE",
            "city": "BASKING RIDGE",
            "state": "NJ",
            "postal_code": "07920",
            "telephone_number": "908-221-1136",
            "fax_number": "908-221-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 SOUTH FINLEY AVE",
            "city": "BASKING RIDGE",
            "state": "NJ",
            "postal_code": "07920",
            "telephone_number": "908-221-1136",
            "fax_number": "908-221-0482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE OMILIA PLASTIC SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-20",
        "last_updated": "2008-04-03",
        "status": "A",
        "authorized_official_last_name": "EVDOKIMOW",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "Z",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-221-1136",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NJ",
            "license": "25MA07315300",
            "primary": true
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "NJ",
            "license": "25MA07315300",
            "primary": false
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "NJ",
            "license": "25MA07315300",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Lynn Dahl, MSN, APN
• Daniel W. Carey, D.D.S., P.C.
• Priyanka Dave
• David Evdokimow, M.D. LLC
• Marjorie E. Davidson, M.A., C.C.C.
• Delta Community Supports, Inc.
• Denis a. Vu, D.M.D., P.C.
• Department of Veterans Affairs, NJ Health Care System
• Lauren Deprima
• Allison Derenzi, DDS

• Oral & Maxillofacial Surgery (D.M.D.) in Basking Ridge, NJ
• Providers in Basking Ridge, NJ by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.