Provider Demographics
NPI:1043568587
Name:SURGICAL FIRST ASSIST SERVICES, LLC
Entity Type:Organization
Organization Name:SURGICAL FIRST ASSIST SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:609-709-8414
Mailing Address - Street 1:1332 OCEAN AVE
Mailing Address - Street 2:UNIT 7
Mailing Address - City:SEA BRIGHT
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-2277
Mailing Address - Country:US
Mailing Address - Phone:609-709-8414
Mailing Address - Fax:
Practice Address - Street 1:32 CORBETT WAY
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2263
Practice Address - Country:US
Practice Address - Phone:609-709-8414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty