Provider Demographics
NPI:1295058006
Name:OMNISURGICAL PARTNERS, LLC
Entity type:Organization
Organization Name:OMNISURGICAL PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-229-5536
Mailing Address - Street 1:570 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4573
Mailing Address - Country:US
Mailing Address - Phone:973-229-5536
Mailing Address - Fax:973-403-1206
Practice Address - Street 1:570 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:NORTH CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-4573
Practice Address - Country:US
Practice Address - Phone:973-229-5536
Practice Address - Fax:973-403-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies