Healthcare Provider Details

I. General information

NPI: 1962854232
Provider Name (Legal Business Name): AFFINITY SURGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 HOMESTEAD RD
PARAMUS NJ
07652-4709
US

IV. Provider business mailing address

205 HOMESTEAD RD
PARAMUS NJ
07652-4709
US

V. Phone/Fax

Practice location:
  • Phone: 516-587-3406
  • Fax:
Mailing address:
  • Phone: 516-587-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMA067801
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TONY JACOB
Title or Position: PRESIDENT
Credential: P.A.
Phone: 516-587-3406