Provider Demographics
NPI:1578113031
Name:IMED SURGICAL OF NEW JERSEY ,PC
Entity Type:Organization
Organization Name:IMED SURGICAL OF NEW JERSEY ,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEACCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-760-1546
Mailing Address - Street 1:113 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0968
Mailing Address - Country:US
Mailing Address - Phone:631-760-1548
Mailing Address - Fax:
Practice Address - Street 1:663 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3012
Practice Address - Country:US
Practice Address - Phone:631-760-1548
Practice Address - Fax:631-761-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA