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General NPI Number Information
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NPI Number | 1801194659
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Entity Type | Organization
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Legal Business Name | MAMSURG THORACIC SURGERY LLC
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Dates
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Enumeration Date | 03/03/2011
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 4013 US HIGHWAY 9
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City | HOWELL
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State | NJ
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Zip | 07731-4021
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Country | US
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Telephone | 732-886-2252
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Fax |
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Provider Business Mailing Address
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Address Line | 4013 US HIGHWAY 9
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City | HOWELL
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State | NJ
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Zip | 07731-4021
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Country | US
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Telephone | 732-886-2252
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/SOLE MEMBER
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Name | DR. VINCE LAVAUGHN MOSS
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Credential | MD
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Telephone | 732-886-2252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 25M080027700
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License Number State | NJ
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