Provider Demographics
NPI:1003908880
Name:RAMAPO VALLEY SURGICAL ASSOCIATES PROF CORP
Entity Type:Organization
Organization Name:RAMAPO VALLEY SURGICAL ASSOCIATES PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-357-8800
Mailing Address - Street 1:100 ROUTE 59
Mailing Address - Street 2:RAMAPO VALLEY SURGICAL ASSOCIATES PC STE 101
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4927
Mailing Address - Country:US
Mailing Address - Phone:845-357-8800
Mailing Address - Fax:845-357-0086
Practice Address - Street 1:100 ROUTE 59
Practice Address - Street 2:RAMAPO VALLEY SURGICAL ASSOCIATES PC STE 101
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4927
Practice Address - Country:US
Practice Address - Phone:845-357-8800
Practice Address - Fax:845-357-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01366247Medicaid
NYW21261Medicare ID - Type Unspecified