NPIMap

Organization Active NPI

Samra Plastic and Reconstructive Surgery LLC

  • Specialist
  • Holmdel, NJ
National Provider Identifier
1508804493
Registry record updated Oct 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
25MA03149800 Issued in NJ
Legal business name
SAMRA PLASTIC AND RECONSTRUCTIVE SURGERY LLC
Practice address
733 N Beers St
Suite U1
Holmdel, NJ 07733-1528
Phone
(732) 739-2100
Fax
(732) 739-1002
NPI assigned
Jun 3, 2006
Last updated
Oct 23, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2007

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

Authorized official

Name
Nicole Biskup
Title
Office Manager
Phone
(732) 739-2100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 25MA07712600 NJ
Specialist 174400000X 25MA03149800 NJ Primary

Addresses

Primary practice location

733 N Beers St
Suite U1
Holmdel, NJ 07733-1528

Mailing address

733 N Beers St
Suite U1
Holmdel, NJ 07733-1528
Phone (732) 739-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060608000249 NJ Part B Supplier - Clinic/Group Practice 3274545330 Receives reassigned benefits from 11 practitioners
Practice locations: Holmdel, NJ; Old Bridge, NJ

National Provider Directory

National Provider Directory

Locations

733 N Beers St
Ste L5
Holmdel, NJ 07733
Phone (732) 739-2100

733 N Beers St
Ste U1
Holmdel, NJ 07733
Phone (732) 739-2100

200 Perrine Rd
Ste 228
Old Bridge, NJ 08857
Phone (708) 727-8800

300 Perrine Rd
Ste 333
Old Bridge, NJ 08857
Phone (732) 289-9335

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193097600000",
    "number": "1508804493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "733 N BEERS ST",
            "address_2": "SUITE U1",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077331528",
            "telephone_number": "732-739-2100",
            "fax_number": "732-739-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "733 N BEERS ST",
            "address_2": "SUITE U1",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077331528",
            "telephone_number": "732-739-2100",
            "fax_number": "732-739-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMRA PLASTIC AND RECONSTRUCTIVE SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2007-10-23",
        "status": "A",
        "authorized_official_last_name": "BISKUP",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "732-739-2100"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA07712600",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA03149800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holmdel, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.