MEDICARE: GARDEN STATE SURGICAL ASSOCIATES, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0197712000	OTHER	NJ	AMERIHEALTH

General Provider Information

NPI Number	:	1881633790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN STATE SURGICAL ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	1511 PARK AVE
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-5516
Country	:	US
Telephone Number	:	908-561-9500
Fax Number	:	908-561-7162

Provider Business Practice Location Address
First Line	:	1511 PARK AVE
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-5516
Country	:	US
Telephone Number	:	908-561-9500
Fax Number	:	908-561-7162

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID M RICHMAND
Credential	:	M.D.
Telephone Number	:	908-561-9500

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	02/21/2008

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