Provider Demographics
NPI:1598814113
Name:PRN SURGICAL ASSISTANCE
Entity Type:Organization
Organization Name:PRN SURGICAL ASSISTANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:CAROLYN
Authorized Official - Last Name:MALECKA
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:856-985-9375
Mailing Address - Street 1:9 PONTIAC DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8115
Mailing Address - Country:US
Mailing Address - Phone:856-985-9375
Mailing Address - Fax:856-985-9375
Practice Address - Street 1:9 PONTIAC DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8115
Practice Address - Country:US
Practice Address - Phone:856-985-9375
Practice Address - Fax:856-985-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR06899400163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty