Provider Demographics
NPI:1245425040
Name:MARTA GENERAL SUGERY, LLC
Entity Type:Organization
Organization Name:MARTA GENERAL SUGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:MARTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-574-5281
Mailing Address - Street 1:1086 TEANECK RD
Mailing Address - Street 2:SUITE 4F1
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4854
Mailing Address - Country:US
Mailing Address - Phone:201-530-5520
Mailing Address - Fax:201-530-5519
Practice Address - Street 1:1086 TEANECK RD
Practice Address - Street 2:SUITE 4F1
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4854
Practice Address - Country:US
Practice Address - Phone:201-530-5520
Practice Address - Fax:201-530-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08248700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ118474Medicare PIN