Provider Demographics
NPI:1356645204
Name:PRESTIGE SURGICAL CENTER
Entity Type:Organization
Organization Name:PRESTIGE SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:336-575-2833
Mailing Address - Street 1:40 SE 5TH ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-6003
Mailing Address - Country:US
Mailing Address - Phone:561-368-7118
Mailing Address - Fax:561-368-7116
Practice Address - Street 1:146 ROUTE 17 NORTH
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-441-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical