Provider Demographics
NPI:1508886383
Name:ENDO-SURGICAL ASSOCIATES OF CENTRAL NJ
Entity Type:Organization
Organization Name:ENDO-SURGICAL ASSOCIATES OF CENTRAL NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-761-1740
Mailing Address - Street 1:901 W MAIN ST
Mailing Address - Street 2:MEDICAL ARTS BUILDING SUITE 104
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-761-1740
Mailing Address - Fax:732-761-8320
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:MEDICAL ARTS BUILDING SUITE 104
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-761-1740
Practice Address - Fax:732-761-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ159070208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0014958Medicaid
NJ0014958Medicaid
NJA61512Medicare UPIN
NJ074730Medicare ID - Type Unspecified