Healthcare Provider Details

I. General information

NPI: 1972761138
Provider Name (Legal Business Name): WILD SURGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 ENGLISH CREEK RD
PORT REPUBLIC NJ
08241-9794
US

IV. Provider business mailing address

321 ENGLISH CREEK RD
PORT REPUBLIC NJ
08241-9794
US

V. Phone/Fax

Practice location:
  • Phone: 609-652-1276
  • Fax: 609-652-7498
Mailing address:
  • Phone: 609-652-1276
  • Fax: 609-652-7498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MARY K WILD
Title or Position: OWNER
Credential: RN CRNFA
Phone: 609-350-2211