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General NPI Number Information
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NPI Number | 1710344155
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Entity Type | Organization
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Legal Business Name | EMPIRE SURGICAL ASSISTANTS, LLC
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Dates
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Enumeration Date | 01/15/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 264 BOYDEN AVE
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3070
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Country | US
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Telephone | 973-761-5200
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Fax | 973-761-7617
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Provider Business Mailing Address
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Address Line | 264 BOYDEN AVE
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3070
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Country | US
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Telephone | 973-761-5200
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Fax | 973-761-7617
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Authorized Official
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Title or Position | CEO
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Name | DR. NADER MOAVEN
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Credential | MD
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Telephone | 973-376-0540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MA05812900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MA05812900
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 25MA05812900
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License Number State | NJ
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