Healthcare Provider Details

I. General information

NPI: 1568744779
Provider Name (Legal Business Name): SURGXCEL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HOFFMAN AVE
LAKE HIAWATHA NJ
07034-2320
US

IV. Provider business mailing address

SURGXCEL, LLC 211 RIDGE DRIVE
POMPTON LAKES NJ
07442
US

V. Phone/Fax

Practice location:
  • Phone: 917-864-8957
  • Fax:
Mailing address:
  • Phone: 917-864-8957
  • Fax: 973-706-8806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00235200
License Number StateNJ

VIII. Authorized Official

Name: MR. DEWANG H RAWAL
Title or Position: CEO
Credential: PA-C
Phone: 917-864-8957