Healthcare Provider Details

I. General information

NPI: 1184643322
Provider Name (Legal Business Name): JERSEY SURGERY, P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3467 W HILLSBORO BLVD SUITE B
DEERFIELD BEACH FL
33442-9473
US

IV. Provider business mailing address

3467 W HILLSBORO BLVD SUITE B
DEERFIELD BEACH FL
33442-9473
US

V. Phone/Fax

Practice location:
  • Phone: 954-574-0252
  • Fax: 954-429-1759
Mailing address:
  • Phone: 954-574-0252
  • Fax: 954-429-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA B JAHN
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-574-0252