Provider Demographics
NPI:1164637559
Name:SURGICAL ASSOCIATES OF HUDSON COUNTY, P.A.
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF HUDSON COUNTY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENETTA
Authorized Official - Middle Name:LEVINE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-420-7903
Mailing Address - Street 1:330 GRAND ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2728
Mailing Address - Country:US
Mailing Address - Phone:201-420-7903
Mailing Address - Fax:
Practice Address - Street 1:330 GRAND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2728
Practice Address - Country:US
Practice Address - Phone:201-420-7903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1037609Medicaid
NJ1037609Medicaid
NJF60423Medicare UPIN