Healthcare Provider Details

I. General information

NPI: 1881986685
Provider Name (Legal Business Name): NORTH JERSEY SURGICAL ASSISTANT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 KIPP AVE FLOOR 2
HASBROUCK HEIGHTS NJ
07604-2614
US

IV. Provider business mailing address

455 KIPP AVE FLOOR 2
HASBROUCK HEIGHTS NJ
07604-2614
US

V. Phone/Fax

Practice location:
  • Phone: 201-727-9330
  • Fax: 201-425-4527
Mailing address:
  • Phone: 201-727-9330
  • Fax: 201-425-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. MICHELLE LASKI
Title or Position: OWNER
Credential: BSN
Phone: 201-727-9330