Provider Demographics
NPI:1407244437
Name:EDGE SURGICAL GROUP PC
Entity Type:Organization
Organization Name:EDGE SURGICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURIZIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGLIETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-280-6150
Mailing Address - Street 1:36 MCGRATH DR
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-1745
Mailing Address - Country:US
Mailing Address - Phone:201-280-6150
Mailing Address - Fax:888-909-4197
Practice Address - Street 1:36 MCGRATH DR
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-1745
Practice Address - Country:US
Practice Address - Phone:201-280-6150
Practice Address - Fax:888-909-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB067108208600000X
2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty