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NEW JERSEY PLASTIC SURGERY
NPI 1073284675
Plastic Surgery in Montclair, NJ

Active since September 23, 2021CLIA 31D2004050 · Waiver
29 PARK ST, MONTCLAIR, NJ 07042(973) 509-2000 Get Directions Write a Review

NPPES record last updated: September 28, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 28, 2021, Sep 23, 2021 (2 updates tracked since 2021).

About New Jersey Plastic Surgery NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NEW JERSEY PLASTIC SURGERY (NPI 1073284675) is a healthcare organization registered as a plastic surgery in Montclair, New Jersey and active in the NPI registry since September 2021. The organization holds a CLIA Waiver certificate valid through February 23, 2028 and lists Shirlee Wilson, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1073284675
Entity TypeOrganization
Primary Taxonomy208200000X
Legal Business NameNEW JERSEY PLASTIC SURGERY
Location Address29 PARK STMontclair, NJ 07042-3407
Mailing Address29 Park StMontclair, NJ 07042-3407 · (973) 509-2000
Phone(973) 509-2000
Organization SubpartNo
Authorized OfficialShirlee WilsonOffice Manager · (973) 509-2000
Enumeration DateSeptember 23, 2021
Last NPPES UpdateSeptember 28, 20212 updates tracked since enumeration
NPPES CertifiedSeptember 28, 2021
✔ NPI 1073284675 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPlastic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208200000X
Definition
A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.
29 PARK ST, Montclair, NJ 07042
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Other Identifiers 3

Medicaid1164599262NJ
Medicaid1942563564NJ
Medicaid1427342971TX

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 31D2004050

New Jersey Plastic Surgery · Montclair, NJ
Active · expires Feb 23, 2028
CLIA Number31D2004050
Laboratory TypePhysician Office
Certificate Effective DateFebruary 24, 2026
Certificate Expiration DateFebruary 23, 2028
Laboratory DirectorBarry E. Dibernardo MD
Laboratory Phone(973) 509-2000
Laboratory LocationNew Jersey Plastic Surgery29 Park Street, Montclair, NJ 07042
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDREA CACCIARELLI MD LLC
Surgery (Plastic and Reconstructive Surgery)
29 PARK ST
MONTCLAIR, NJ 07042
Essex County (973) 364-0135
DR. ANDREA CACCIARELLI
Plastic Surgery
29 PARK ST
MONTCLAIR, NJ 07042
Essex County (973) 364-0135
DR. BARRY E DIBERNARDO MD, P.C.
Surgery (Plastic and Reconstructive Surgery)
29 PARK ST
MONTCLAIR, NJ 07042
Essex County (973) 509-2000
HARRY T HARAMIS MD
Surgery (Plastic and Reconstructive Surgery)
29 PARK ST
MONTCLAIR, NJ 07042
Essex County (973) 509-2000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is New Jersey Plastic Surgery's NPI number?

The NPI number for New Jersey Plastic Surgery is 1073284675. It was assigned to this organization in the NPPES registry on September 23, 2021.

Where is New Jersey Plastic Surgery located?

New Jersey Plastic Surgery is located at 29 Park St, Montclair, NJ 07042. The listed phone number is (973) 509-2000.

What is New Jersey Plastic Surgery's specialty?

The primary specialty registered for this NPI is Plastic Surgery with taxonomy code 208200000X.

Does New Jersey Plastic Surgery hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 31D2004050) is associated with this NPI, valid through February 23, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for New Jersey Plastic Surgery was last updated on September 28, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.