Healthcare Provider Details

I. General information

NPI: 1124377981
Provider Name (Legal Business Name): MAGA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TOBOGGAN RIDGE RD
SADDLE RIVER NJ
07458-2521
US

IV. Provider business mailing address

PO BOX 2701
FAIR LAWN NJ
07410-8601
US

V. Phone/Fax

Practice location:
  • Phone: 201-791-7760
  • Fax:
Mailing address:
  • Phone: 201-791-7760
  • Fax: 201-791-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK GALPERIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-791-7760