Provider Demographics
NPI:1033302641
Name:PROFESSIONAL SURGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:PROFESSIONAL SURGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:DABIEN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:786-390-4789
Mailing Address - Street 1:8814 NW 180TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6503
Mailing Address - Country:US
Mailing Address - Phone:786-390-4789
Mailing Address - Fax:
Practice Address - Street 1:8814 NW 180TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6503
Practice Address - Country:US
Practice Address - Phone:786-390-4789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101660363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291175200Medicaid
FL291175200Medicaid