Provider Demographics
NPI:1396038196
Name:NORTH EASTERN SURGERY GROUP CORP
Entity Type:Organization
Organization Name:NORTH EASTERN SURGERY GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-257-0709
Mailing Address - Street 1:PO BOX 3619
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984
Mailing Address - Country:US
Mailing Address - Phone:787-257-0709
Mailing Address - Fax:787-276-4275
Practice Address - Street 1:132 11 ROBERTO CLEMENTE AVE.
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-257-0709
Practice Address - Fax:787-276-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty