Provider Demographics
NPI:1639552144
Name:PARK WEST SURGICAL GROUP LLC
Entity Type:Organization
Organization Name:PARK WEST SURGICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ARGYRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAVROGIORGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-862-9300
Mailing Address - Street 1:75 S DEAN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3512
Mailing Address - Country:US
Mailing Address - Phone:201-862-9300
Mailing Address - Fax:201-608-6852
Practice Address - Street 1:75 CENTRAL PARK W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6055
Practice Address - Country:US
Practice Address - Phone:201-871-4000
Practice Address - Fax:201-608-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty