Provider Demographics
NPI:1235779653
Name:NORTHEASTERN SURGICAL SPECIALISTS
Entity Type:Organization
Organization Name:NORTHEASTERN SURGICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUMANOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-991-9868
Mailing Address - Street 1:520 8TH ST NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5118
Mailing Address - Country:US
Mailing Address - Phone:866-991-9868
Mailing Address - Fax:828-256-5885
Practice Address - Street 1:168 KINSLEY ST STE 2
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3634
Practice Address - Country:US
Practice Address - Phone:603-884-3963
Practice Address - Fax:603-578-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty