Healthcare Provider Details

I. General information

NPI: 1689003196
Provider Name (Legal Business Name): FIRST ASSIST SURGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 06/03/2016
Certification Date:
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 TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00294500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine 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:
Phone: 516-587-3406