=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407255045
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL JERSEY HAND SURGERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2014
-----------------------------------------------------
Last Update Date | 08/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 IRON BRIDGE RD
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-462-7700
-----------------------------------------------------
Fax | 732-431-4770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 INDUSTRIAL WAY W
-----------------------------------------------------
City | EATONTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07724-2265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-542-4477
-----------------------------------------------------
Fax | 732-935-0355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DR. GARY M PESS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 732-542-4477
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 25MAO4833900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------