Provider Demographics
NPI:1598784761
Name:CENTRAL JERSEY SPECIALTY SURGICAL ASSOCIATES,LLC
Entity Type:Organization
Organization Name:CENTRAL JERSEY SPECIALTY SURGICAL ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:732-389-1331
Mailing Address - Street 1:10 INDUSTRIAL WAY E
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3332
Mailing Address - Country:US
Mailing Address - Phone:732-389-1331
Mailing Address - Fax:732-542-8587
Practice Address - Street 1:10 INDUSTRIAL WAY E
Practice Address - Street 2:SUITE 104
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3332
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:2006-07-19
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66353208600000X
NJMA51693208C00000X
NJMB63380208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8296901Medicaid
NJ020736Medicare ID - Type Unspecified