Provider Demographics
NPI:1073743563
Name:ABBEY ROAD OFFICE BASED SURGERY PLLC
Entity Type:Organization
Organization Name:ABBEY ROAD OFFICE BASED SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:JETTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-517-5200
Mailing Address - Street 1:737 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4256
Mailing Address - Country:US
Mailing Address - Phone:212-517-5200
Mailing Address - Fax:212-737-5657
Practice Address - Street 1:737 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4256
Practice Address - Country:US
Practice Address - Phone:212-517-5200
Practice Address - Fax:212-737-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical