1184053290 NPI number — MEDEAST POST-OP & SURGICAL, INC.

Table of content: (NPI 1184053290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184053290 NPI number — MEDEAST POST-OP & SURGICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDEAST POST-OP & SURGICAL, INC.
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:
Provider Other Organization Name Type Code:
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:
1184053290
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
496 KINGS HWY N STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08034-1015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2591 BAGLYOS CIR
Provider Second Line Business Practice Location Address:
SUITE C-43
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18020-8043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-829-2030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BLASKOVICH
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
609-332-4703

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1022940370001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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