Healthcare Provider Details

I. General information

NPI: 1417044744
Provider Name (Legal Business Name): SURGIPLEX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E RIDGEWOOD AVE
PARAMUS NJ
07652-4038
US

IV. Provider business mailing address

122 E RIDGEWOOD AVE
PARAMUS NJ
07652-4038
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-1212
  • Fax: 201-262-6270
Mailing address:
  • Phone: 972-758-3598
  • Fax: 972-599-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2715
License Number StateNJ

VIII. Authorized Official

Name: DR. PAUL M. PARKER
Title or Position: OWNER
Credential: MD
Phone: 201-967-1212