Healthcare Provider Details

I. General information

NPI: 1801410154
Provider Name (Legal Business Name): SYNERGY SURGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 RATZER RD
WAYNE NJ
07470-2311
US

IV. Provider business mailing address

1247 RATZER RD
WAYNE NJ
07470-2311
US

V. Phone/Fax

Practice location:
  • Phone: 888-851-3677
  • Fax: 888-851-3671
Mailing address:
  • Phone: 888-851-3677
  • Fax: 888-851-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW MCDONNELL,
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 732-221-9073