1114249059 NPI number — ATLANTIC SURGICAL ASSISTANTS LLC

Table of content: (NPI 1114249059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114249059 NPI number — ATLANTIC SURGICAL ASSISTANTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC SURGICAL ASSISTANTS 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:
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:
1114249059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08240-0351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-965-4491
Provider Business Mailing Address Fax Number:
609-804-0214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
266 SOUTH ODESSA AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-965-4491
Provider Business Practice Location Address Fax Number:
609-804-0214
Provider Enumeration Date:
02/19/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CALIMER
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
609-965-4491

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  26NO06448800 , 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: 1891818217 . This is a "NPI TYPE I" identifier . This identifiers is of the category "OTHER".