=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023640539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | META SURGICAL ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2020
-----------------------------------------------------
Last Update Date | 02/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 CHESTNUT RIDGE RD
-----------------------------------------------------
City | MONTVALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07645-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-799-4014
-----------------------------------------------------
Fax | 201-746-9104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 CHESTNUT RIDGE RD
-----------------------------------------------------
City | MONTVALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07645-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-799-4014
-----------------------------------------------------
Fax | 201-746-9104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MARISSA SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-799-4014
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------