Healthcare Provider Details

I. General information

NPI: 1275669343
Provider Name (Legal Business Name): COLON & RECTAL SURGERY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE SUITE 811
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

20 PROSPECT AVE SUITE 811
HACKENSACK NJ
07601-1997
US

V. Phone/Fax

Practice location:
  • Phone: 201-525-1660
  • Fax: 201-525-1667
Mailing address:
  • Phone: 201-525-1660
  • Fax: 201-525-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35677
License Number StateNJ

VIII. Authorized Official

Name: DR. MARK EDWIN HELBRAUN
Title or Position: PRESIDENT
Credential: MD
Phone: 201-525-1660