Healthcare Provider Details

I. General information

NPI: 1962320028
Provider Name (Legal Business Name): ENERGY SURGICAL CONSULTANT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CLOVER RD
NEWFOUNDLAND NJ
07435-1712
US

IV. Provider business mailing address

12 CLOVER RD
NEWFOUNDLAND NJ
07435-1712
US

V. Phone/Fax

Practice location:
  • Phone: 973-886-6237
  • Fax:
Mailing address:
  • Phone: 973-886-6237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: NICOLE GAREY
Title or Position: PHYSICIAN ASSISTANT
Credential: MPAS, PA-C
Phone: 973-886-6237