Healthcare Provider Details

I. General information

NPI: 1366498347
Provider Name (Legal Business Name): MINIMALLY INVASIVE SURGERY CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NEW RD
LINWOOD NJ
08221-1036
US

IV. Provider business mailing address

1801 NEW RD
LINWOOD NJ
08221-1036
US

V. Phone/Fax

Practice location:
  • Phone: 609-653-3055
  • Fax: 609-653-8469
Mailing address:
  • Phone: 609-653-3055
  • Fax: 609-653-8469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. BURHAN HALEEM
Title or Position: CFO
Credential: DO
Phone: 855-727-2465