Provider Demographics
NPI:1629024757
Name:FARES SURGICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:FARES SURGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:FARES
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:609-585-1400
Mailing Address - Street 1:1345 KUSER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3823
Mailing Address - Country:US
Mailing Address - Phone:609-585-1400
Mailing Address - Fax:609-585-2988
Practice Address - Street 1:1345 KUSER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3823
Practice Address - Country:US
Practice Address - Phone:609-585-1400
Practice Address - Fax:609-585-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0073417001OtherAMERIHEALTH GROUP NUMBER
NJ=========OtherEIN
NJ039419Medicare ID - Type UnspecifiedGROUP NUMBER
NJ=========OtherEIN
NJC53896Medicare UPIN
199762AFHMedicare PIN
117491AFHMedicare PIN
477146AFHMedicare PIN
E55065Medicare UPIN
NJD96584Medicare UPIN
116719AFHMedicare PIN