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General NPI Number Information
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NPI Number | 1730326356
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Entity Type | Organization
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Legal Business Name | ADVANCED LAPAROSCOPIC SPECIALISTS
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Dates
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Enumeration Date | 01/20/2009
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Last Update Date | 01/20/2009
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Provider Practice Location Address
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Address Line | 61 N MAPLE AVE SUITE 205
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3255
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Country | US
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Telephone | 201-447-2808
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Fax |
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Provider Business Mailing Address
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Address Line | 61 N MAPLE AVE SUITE 205
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3255
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Country | US
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Telephone | 201-447-2808
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Fax |
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Authorized Official
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Title or Position | SURGEON/PARTNER
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Name | DR. RICHARD ANTHONY PUCCI
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Credential | D.O,
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Telephone | 201-447-2808
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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 | 25MB07801000
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License Number State | NJ
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