Healthcare Provider Details

I. General information

NPI: 1992734677
Provider Name (Legal Business Name): TRUESDALE SURGICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 PRESIDENT AVE SUITE 3002
FALL RIVER MA
02720
US

IV. Provider business mailing address

1030 PRESIDENT AVE SUITE 3002
FALL RIVER MA
02720
US

V. Phone/Fax

Practice location:
  • Phone: 508-676-3411
  • Fax: 508-676-0932
Mailing address:
  • Phone: 508-676-3411
  • Fax: 508-676-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD J MONCHIK
Title or Position: PRESIDENT
Credential: MD
Phone: 508-676-3411