Healthcare Provider Details

I. General information

NPI: 1104264555
Provider Name (Legal Business Name): PINNACLE ENT ALLIANCE OF NEW JERSEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 S DELSEA DR SUITE D
VINELAND NJ
08360-7056
US

IV. Provider business mailing address

994 OLD EAGLE SCHOOL RD SUITE 1017
WAYNE PA
19087-1802
US

V. Phone/Fax

Practice location:
  • Phone: 856-205-0800
  • Fax: 856-205-0024
Mailing address:
  • Phone: 610-902-6092
  • Fax: 610-902-6081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARC I SURKIN
Title or Position: PRESIDENT
Credential: MD
Phone: 610-902-6092