Healthcare Provider Details

I. General information

NPI: 1639060387
Provider Name (Legal Business Name): HERITAGE SURGICAL PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 POST RD STE M9
OAKLAND NJ
07436-1615
US

IV. Provider business mailing address

9 POST RD STE M9
OAKLAND NJ
07436-1615
US

V. Phone/Fax

Practice location:
  • Phone: 201-833-2888
  • Fax: 201-833-2888
Mailing address:
  • Phone: 201-833-2888
  • Fax: 201-833-2888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID RADVINSKY
Title or Position: MEMBER
Credential: MD
Phone: 201-833-2888