Healthcare Provider Details

I. General information

NPI: 1770997603
Provider Name (Legal Business Name): QUALIFIED SURGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3697 CAMERON DR NE
LACEY WA
98516
US

IV. Provider business mailing address

695 US HIGHWAY 46 SUITE 400A
FAIRFIELD NJ
07004-1592
US

V. Phone/Fax

Practice location:
  • Phone: 973-894-1263
  • Fax: 888-972-3703
Mailing address:
  • Phone: 973-826-8080
  • Fax: 866-309-3354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BARRY A COHEN
Title or Position: MBR
Credential: MD
Phone: 973-826-8285