Healthcare Provider Details

I. General information

NPI: 1972158723
Provider Name (Legal Business Name): 380 SURGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MEADOWLANDS PKWY STE 5
SECAUCUS NJ
07094-2306
US

IV. Provider business mailing address

3206 TOWER OAKS BLVD STE 220
ROCKVILLE MD
20852-4254
US

V. Phone/Fax

Practice location:
  • Phone: 301-603-2622
  • Fax:
Mailing address:
  • Phone: 301-603-2622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: EVAN HAMMERMAN
Title or Position: GENERAL COUNSEL
Credential:
Phone: 301-652-4800