Provider Demographics
NPI:1851345870
Name:SURGICAL SPECIALISTS OF NEW JERSEY, LLC
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOYNTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-669-6061
Mailing Address - Street 1:2 EVES DRIVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3193
Mailing Address - Country:US
Mailing Address - Phone:856-669-6061
Mailing Address - Fax:856-384-6015
Practice Address - Street 1:2 EVES DRIVE
Practice Address - Street 2:SUITE 109
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3193
Practice Address - Country:US
Practice Address - Phone:856-669-6061
Practice Address - Fax:856-651-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077519Medicare ID - Type Unspecified