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General NPI Number Information
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NPI Number | 1487812418
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Entity Type | Organization
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Legal Business Name | SELECT SURGICAL SPECIALISTS
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 502 HAMBURG TPKE SUITE 105
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City | WAYNE
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State | NJ
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Zip | 07470-8431
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Country | US
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Telephone | 973-790-7655
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Fax | 973-942-8818
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Provider Business Mailing Address
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Address Line | 502 HAMBURG TPKE SUITE 105
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City | WAYNE
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State | NJ
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Zip | 07470-8431
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Country | US
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Telephone | 973-790-7655
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Fax | 973-942-8818
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS KATHY FUENTES
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Credential |
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Telephone | 973-790-7655
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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 | MA40452
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License Number State | NJ
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