Provider Demographics
NPI:1952661381
Name:ALLI SURGICAL ASSOCIATES,LLC
Entity Type:Organization
Organization Name:ALLI SURGICAL ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PADMAVATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-429-9844
Mailing Address - Street 1:21 BAKLEY TER
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2169
Mailing Address - Country:US
Mailing Address - Phone:973-429-9844
Mailing Address - Fax:973-429-9858
Practice Address - Street 1:557 BROAD ST
Practice Address - Street 2:SUITE # 22
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2885
Practice Address - Country:US
Practice Address - Phone:973-429-9844
Practice Address - Fax:973-429-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB063954208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7045301Medicaid
NJG35190Medicare UPIN