Provider Demographics
NPI:1053672915
Name:MONMOUTH SURGICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:MONMOUTH SURGICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:W
Authorized Official - Last Name:STROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-845-6363
Mailing Address - Street 1:201 W PASSAIC ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3100
Mailing Address - Country:US
Mailing Address - Phone:201-845-6363
Mailing Address - Fax:201-845-0882
Practice Address - Street 1:727 N BEERS ST
Practice Address - Street 2:SUITE 2 EAST
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1514
Practice Address - Country:US
Practice Address - Phone:732-739-5925
Practice Address - Fax:732-290-7067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00000OtherREG NUMBER