Healthcare Provider Details

I. General information

NPI: 1295058006
Provider Name (Legal Business Name): OMNISURGICAL PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 MOUNTAIN AVE
NORTH CALDWELL NJ
07006-4573
US

IV. Provider business mailing address

570 MOUNTAIN AVE
NORTH CALDWELL NJ
07006-4573
US

V. Phone/Fax

Practice location:
  • Phone: 973-229-5536
  • Fax: 973-403-1206
Mailing address:
  • Phone: 973-229-5536
  • Fax: 973-403-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY STEPHEN PEREZ
Title or Position: MANAGING PARTNER
Credential:
Phone: 973-229-5536