Healthcare Provider Details

I. General information

NPI: 1598669228
Provider Name (Legal Business Name): PRECISION SURGICAL ASSIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 VILLA PL
NUTLEY NJ
07110-1919
US

IV. Provider business mailing address

19 VILLA PL
NUTLEY NJ
07110-1919
US

V. Phone/Fax

Practice location:
  • Phone: 516-312-8448
  • Fax:
Mailing address:
  • Phone: 516-312-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EMAUS SANTIAGO
Title or Position: OWNER
Credential: PA
Phone: 516-312-8448