Provider Demographics
NPI:1497776116
Name:LAPAROSCOPIC SPECIALTY SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:LAPAROSCOPIC SPECIALTY SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:732-389-1331
Mailing Address - Street 1:1131 BROAD ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4329
Mailing Address - Country:US
Mailing Address - Phone:732-389-1331
Mailing Address - Fax:732-542-8587
Practice Address - Street 1:1131 BROAD ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4329
Practice Address - Country:US
Practice Address - Phone:732-389-1331
Practice Address - Fax:732-542-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66353208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH13828Medicare UPIN