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General NPI Number Information
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NPI Number | 1023000130
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Entity Type | Organization
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Legal Business Name | MID-ATLANTIC SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 1944 ROUTE 33 STE 201
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City | NEPTUNE
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State | NJ
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Zip | 07753-4862
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Country | US
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Telephone | 732-776-4622
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Fax | 732-776-3765
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Provider Business Mailing Address
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Address Line | MID-ATLANTIC SURGICAL ASSOCIATES 100 MADISON AVE
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City | MORRISTOWN
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State | NJ
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Zip | 07960
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Country | US
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Telephone | 973-971-7300
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Fax | 973-984-7019
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DOUGLAS A IRVIN
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Credential |
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Telephone | 973-971-7307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State | NJ
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