Provider Demographics
NPI:1457698805
Name:SURGERY SERVICES
Entity Type:Organization
Organization Name:SURGERY SERVICES
Other - Org Name:SURGERY SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:CAREEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-894-1263
Mailing Address - Street 1:PO BOX 4059
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-4059
Mailing Address - Country:US
Mailing Address - Phone:973-826-1540
Mailing Address - Fax:855-834-5435
Practice Address - Street 1:155 WILLOWBROOK BLVD STE 410
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7033
Practice Address - Country:US
Practice Address - Phone:973-826-8080
Practice Address - Fax:866-309-3354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5412579OtherUHC
NJDW5358OtherRR MEDICARE