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General NPI Number Information
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NPI Number | 1124459714
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SURGICALCARE, LLC
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Dates
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Enumeration Date | 12/06/2013
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 313 BEDFORD RD
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-1327
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Country | US
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Telephone | 201-225-0029
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Fax | 201-225-0031
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Provider Business Mailing Address
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Address Line | 313 BEDFORD ROAD
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City | RIDGEWOOD
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State | NJ
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Zip | 07450
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Country | US
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Telephone | 201-225-0029
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Fax | 201-225-0031
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Authorized Official
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Title or Position | OWNER/PHYSCIAN
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Name | DR. FREDERICK ALEXANDER
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Credential | M.D.
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Telephone | 201-225-0029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA08195900
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License Number State | NJ
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