Provider Demographics
NPI:1952626640
Name:SALARTASH SURGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SALARTASH SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KHASHAYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SALARTASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-926-5000
Mailing Address - Street 1:301 CENTRAL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-8347
Mailing Address - Country:US
Mailing Address - Phone:609-926-5000
Mailing Address - Fax:609-926-2020
Practice Address - Street 1:301 CENTRAL AVE STE D
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-8347
Practice Address - Country:US
Practice Address - Phone:609-926-5000
Practice Address - Fax:609-926-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0599921174400000X
NJNJ31562208600000X
NJMA059212086S0129X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ216927OtherMEDICARE GROUP
NJ3176100Medicaid
NJC53887Medicare UPIN