Provider Demographics
NPI:1063461374
Name:HADDON SURGICAL ASSOC PA
Entity Type:Organization
Organization Name:HADDON SURGICAL ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHAIRMAN OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-547-5522
Mailing Address - Street 1:17 WHITE HORSE PIKE
Mailing Address - Street 2:STE 6
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035
Mailing Address - Country:US
Mailing Address - Phone:856-547-5522
Mailing Address - Fax:856-547-0416
Practice Address - Street 1:17 WHITE HORSE PIKE
Practice Address - Street 2:STE 6
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035
Practice Address - Country:US
Practice Address - Phone:856-547-5522
Practice Address - Fax:856-547-0416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1011715Medicaid
C57741Medicare UPIN
NJ619551Medicare ID - Type Unspecified