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General NPI Number Information
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NPI Number | 1104264555
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Entity Type | Organization
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Legal Business Name | PINNACLE ENT ALLIANCE OF NEW JERSEY LLC
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 06/07/2013
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Provider Practice Location Address
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Address Line | 2835 S DELSEA DR SUITE D
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City | VINELAND
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State | NJ
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Zip | 08360-7056
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Country | US
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Telephone | 856-205-0800
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Fax | 856-205-0024
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Provider Business Mailing Address
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Address Line | 994 OLD EAGLE SCHOOL RD SUITE 1017
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City | WAYNE
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State | PA
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Zip | 19087-1802
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Country | US
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Telephone | 610-902-6092
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Fax | 610-902-6081
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARC I SURKIN
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Credential | MD
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Telephone | 610-902-6092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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