Provider Demographics
NPI:1881633790
Name:GARDEN STATE SURGICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:GARDEN STATE SURGICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHMAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-561-9500
Mailing Address - Street 1:1511 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5516
Mailing Address - Country:US
Mailing Address - Phone:908-561-9500
Mailing Address - Fax:908-561-7162
Practice Address - Street 1:1511 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5516
Practice Address - Country:US
Practice Address - Phone:908-561-9500
Practice Address - Fax:908-561-7162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0197712000OtherAMERIHEALTH
NJ018813Medicare PIN
NJ0197712000OtherAMERIHEALTH