Healthcare Provider Details

I. General information

NPI: 1386934610
Provider Name (Legal Business Name): PEDIATRIC SURGICAL ASSOCIATES,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W CENTURY RD #235
PARAMUS NJ
07652-1433
US

IV. Provider business mailing address

30 W CENTURY RD #235
PARAMUS NJ
07652-1433
US

V. Phone/Fax

Practice location:
  • Phone: 201-225-9440
  • Fax: 201-225-9430
Mailing address:
  • Phone: 201-225-9440
  • Fax: 201-225-9430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA036957
License Number StateNJ

VIII. Authorized Official

Name: DR. RAJINDER P GANDHI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-225-9440