1053730275 NPI number — METROPOLITAN SURGICAL SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053730275 NPI number — METROPOLITAN SURGICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN SURGICAL SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
METROPOLITAN SURGICAL SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053730275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 28758
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10087-8758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-324-7980
Provider Business Mailing Address Fax Number:
973-695-1047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2740 STATE ROUTE 10
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MORRIS PLAINS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-324-7980
Provider Business Practice Location Address Fax Number:
973-695-1047
Provider Enumeration Date:
04/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ITZKOVICH
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
JASON
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
888-324-7980

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  25MA08040300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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