Basic Information
| Provider Information | |||||||||
| NPI: | 1902129042 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SURGERY FIRST LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 ASTER ST | ||||||||
| Address2: | |||||||||
| City: | GLENWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074181908 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 W BLACKWELL ST | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078012525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736256000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2010 | ||||||||
| LastUpdateDate: | 03/03/2010 | ||||||||
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| AuthorizedOfficialLastName: | SHAW | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 9739512626 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RNFA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 26NO11902800 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.