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General NPI Number Information
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NPI Number | 1306271572
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Entity Type | Organization
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Legal Business Name | HERITAGE SURGICAL GROUP, LLC
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Dates
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Enumeration Date | 09/06/2013
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 9 POST RD STE M9
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City | OAKLAND
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State | NJ
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Zip | 07436-1615
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Country | US
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Telephone | 201-833-2888
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Fax | 201-833-1010
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Provider Business Mailing Address
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Address Line | 741 TEANECK RD STE B
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City | TEANECK
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State | NJ
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Zip | 07666-4262
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Country | US
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Telephone | 201-833-2888
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Fax | 201-833-1010
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Authorized Official
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Title or Position | MANAGER
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Name | KELLEY M BYRNES
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Credential |
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Telephone | 201-833-2888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA08710300
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License Number State | NJ
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