Provider Demographics
NPI:1134710866
Name:NORTHERN NEW JERSEY SURGICAL SPECIALISTS PC
Entity type:Organization
Organization Name:NORTHERN NEW JERSEY SURGICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PANAGIOTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-250-4958
Mailing Address - Street 1:185 CEDAR LN FL 1
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 CEDAR LN FL 1
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4316
Practice Address - Country:US
Practice Address - Phone:917-250-4958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty