Provider Demographics
NPI:1720310626
Name:ADVANCED SURGERY INSTITUTE LLC
Entity Type:Organization
Organization Name:ADVANCED SURGERY INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:COSME
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MANZARBEITIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-716-9519
Mailing Address - Street 1:9922 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1705
Mailing Address - Country:US
Mailing Address - Phone:215-464-6040
Mailing Address - Fax:
Practice Address - Street 1:9282 NW 63RD CT
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-3758
Practice Address - Country:US
Practice Address - Phone:484-716-9519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055579L261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care