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General NPI Number Information
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NPI Number | 1780878348
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Entity Type | Organization
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Legal Business Name | SURG-ELITE PC
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 101 OLD SHORT HILLS ROAD SUITE 501
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City | WEST ORANGE
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State | NJ
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Zip | 07052-1080
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Country | US
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Telephone | 973-731-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 65 LARKIN CIRCLE
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City | WEST ORANGE
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State | NJ
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Zip | 07052-1080
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Country | US
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Telephone | 973-731-2000
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | A. PETER SALAS
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Credential | MD, FACS, FACM
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Telephone | 973-731-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 25MA07209200
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License Number State | NJ
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