Healthcare Provider Details

I. General information

NPI: 1851345870
Provider Name (Legal Business Name): SURGICAL SPECIALISTS OF NEW JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EVES DRIVE SUITE 109
MARLTON NJ
08053-3193
US

IV. Provider business mailing address

2 EVES DRIVE SUITE 109
MARLTON NJ
08053-3193
US

V. Phone/Fax

Practice location:
  • Phone: 856-669-6061
  • Fax: 856-651-0853
Mailing address:
  • Phone: 856-669-6061
  • Fax: 856-384-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER J BOYNTON
Title or Position: MANAGING DIRECTOR
Credential: M.D.
Phone: 856-669-6061