Provider Demographics
NPI:1144211822
Name:ELIZABETH SURGICAL GROUP LLC
Entity Type:Organization
Organization Name:ELIZABETH SURGICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:LOPES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-232-2300
Mailing Address - Street 1:155 MORRIS AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1225
Mailing Address - Country:US
Mailing Address - Phone:973-232-2300
Mailing Address - Fax:973-232-2301
Practice Address - Street 1:155 MORRIS AVE
Practice Address - Street 2:SECIND FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1225
Practice Address - Country:US
Practice Address - Phone:973-232-2300
Practice Address - Fax:973-232-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0055158Medicaid
NJ0055158Medicaid