Healthcare Provider Details

I. General information

NPI: 1346488806
Provider Name (Legal Business Name): BURLCO SURGICAL ASSIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 KATHLEEN AVE
CINNAMINSON NJ
08077-2932
US

IV. Provider business mailing address

400 KATHLEEN AVE
CINNAMINSON NJ
08077-2932
US

V. Phone/Fax

Practice location:
  • Phone: 856-829-1182
  • Fax:
Mailing address:
  • Phone: 856-829-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NR0543900
License Number StateNJ

VIII. Authorized Official

Name: MRS. KAREN A ANGEL
Title or Position: RNFA
Credential: RN
Phone: 856-829-1182