Healthcare Provider Details

I. General information

NPI: 1538322177
Provider Name (Legal Business Name): SURGICAL NURSING ASSIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 GERMAIN RD
TABERNACLE NJ
08088-9354
US

IV. Provider business mailing address

18 GERMAIN RD
TABERNACLE NJ
08088-9354
US

V. Phone/Fax

Practice location:
  • Phone: 973-957-0548
  • Fax: 866-395-0888
Mailing address:
  • Phone: 973-957-0548
  • Fax: 866-395-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NR04666900
License Number StateNJ

VIII. Authorized Official

Name: MRS. BARBARA A HARBORA
Title or Position: REGISTERED NURSE
Credential: RNFA
Phone: 609-268-2553