Provider Demographics
NPI:1255524898
Name:ADVANCED SURGICAL CARE, PC
Entity type:Organization
Organization Name:ADVANCED SURGICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-534-0008
Mailing Address - Street 1:21 LAUREL AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1481
Mailing Address - Country:US
Mailing Address - Phone:845-534-0008
Mailing Address - Fax:845-534-0018
Practice Address - Street 1:21 LAUREL AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1469
Practice Address - Country:US
Practice Address - Phone:845-534-0008
Practice Address - Fax:845-534-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217204-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty