Healthcare Provider Details

I. General information

NPI: 1710344155
Provider Name (Legal Business Name): EMPIRE SURGICAL ASSISTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 BOYDEN AVE
MAPLEWOOD NJ
07040-3070
US

IV. Provider business mailing address

264 BOYDEN AVE
MAPLEWOOD NJ
07040-3070
US

V. Phone/Fax

Practice location:
  • Phone: 973-761-5200
  • Fax: 973-761-7617
Mailing address:
  • Phone: 973-761-5200
  • Fax: 973-761-7617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number25MA05812900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MA05812900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MA05812900
License Number StateNJ

VIII. Authorized Official

Name: DR. NADER MOAVEN
Title or Position: CEO
Credential: MD
Phone: 973-376-0540