Provider Demographics
NPI:1770737413
Name:SPECIALTY SURGERY OF MIDDLETOWN, LLC
Entity type:Organization
Organization Name:SPECIALTY SURGERY OF MIDDLETOWN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:MEDAVARAM
Authorized Official - Last Name:VARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-671-5555
Mailing Address - Street 1:1270 ROUTE 35
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2014
Mailing Address - Country:US
Mailing Address - Phone:732-671-5555
Mailing Address - Fax:732-671-5502
Practice Address - Street 1:1270 ROUTE 35
Practice Address - Street 2:SUITE 3
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2014
Practice Address - Country:US
Practice Address - Phone:732-671-5555
Practice Address - Fax:732-671-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical