Provider Demographics
NPI:1336446863
Name:GARDEN STATE MEDICAL AND SURGICAL GROUP, LLC
Entity Type:Organization
Organization Name:GARDEN STATE MEDICAL AND SURGICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-461-6666
Mailing Address - Street 1:1608 LEMOINE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5622
Mailing Address - Country:US
Mailing Address - Phone:201-461-6666
Mailing Address - Fax:201-461-7429
Practice Address - Street 1:1608 LEMOINE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5622
Practice Address - Country:US
Practice Address - Phone:201-461-6666
Practice Address - Fax:201-461-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05840700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty