1366498347 NPI number — MINIMALLY INVASIVE SURGERY CENTER, P.A.

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 1366498347 NPI number — MINIMALLY INVASIVE SURGERY CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINIMALLY INVASIVE SURGERY CENTER, P.A.
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:
1366498347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 NEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08221-1036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-653-3055
Provider Business Mailing Address Fax Number:
609-653-8469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 NEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08221-1036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-653-3055
Provider Business Practice Location Address Fax Number:
609-653-8469
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALEEM
Authorized Official First Name:
BURHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
855-727-2465

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , 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)

  • Identifier: 0001498000 . This is a "AMERIHEALTH PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0535729 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 311127 . This is a "HORIZON PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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