Provider Demographics
NPI:1124229349
Name:PROFESSIONAL ASSOCIATES IN SURGERY, LLP
Entity Type:Organization
Organization Name:PROFESSIONAL ASSOCIATES IN SURGERY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHESHWARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-731-5005
Mailing Address - Street 1:101 OLD SHORT HILLS ROAD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052
Mailing Address - Country:US
Mailing Address - Phone:973-731-5005
Mailing Address - Fax:973-325-6230
Practice Address - Street 1:101 OLD SHORT HILLS ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-731-5005
Practice Address - Fax:973-325-6230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8784507Medicaid
NJ047328Medicare ID - Type Unspecified