Provider Demographics
NPI:1750397386
Name:JSE SURGICAL ONCOLOGY ASSOCIATES A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:JSE SURGICAL ONCOLOGY ASSOCIATES A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ECONOMOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-600-8370
Mailing Address - Street 1:528 PALISADES DR # 216
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2844
Mailing Address - Country:US
Mailing Address - Phone:310-600-8370
Mailing Address - Fax:
Practice Address - Street 1:10833 LE CONTE AVE RM 54-140
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-825-2644
Practice Address - Fax:310-825-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0024820Medicaid
CAW10086Medicare ID - Type Unspecified