Provider Demographics
NPI:1740261064
Name:GALLOPING HILL SURGICAL, LLC
Entity type:Organization
Organization Name:GALLOPING HILL SURGICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WINTHROP
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-244-4660
Mailing Address - Street 1:593 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-2938
Mailing Address - Country:US
Mailing Address - Phone:732-251-8000
Mailing Address - Fax:866-511-0294
Practice Address - Street 1:593 NASSAU ST
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-2938
Practice Address - Country:US
Practice Address - Phone:732-251-8000
Practice Address - Fax:866-511-0294
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PASSAIC HEALTHCARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-14
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ56744OtherNORTHWOOD
NJ6774903Medicaid
NJ565144OtherAETNA
NJ0002632000OtherAMERIHEALTH
NJMI0000352OtherAMERICHOICE
NJ47462OtherAMERIGROUP
NJ47462OtherAMERIGROUP