Provider Demographics
NPI:1023196227
Name:SURGICAL SPECIALISTS OF NEW JERSEY
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:976-539-6900
Mailing Address - Street 1:95 MADISON AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6092
Mailing Address - Country:US
Mailing Address - Phone:976-539-6900
Mailing Address - Fax:973-538-4115
Practice Address - Street 1:95 MADISON AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6092
Practice Address - Country:US
Practice Address - Phone:976-539-6900
Practice Address - Fax:973-538-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ886582Medicare ID - Type Unspecified