Provider Demographics
NPI:1710269980
Name:NEW JERSEY LAPROSCOPIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:NEW JERSEY LAPROSCOPIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RV
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-744-8585
Mailing Address - Street 1:230 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1529
Practice Address - Country:US
Practice Address - Phone:973-744-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty