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General NPI Number Information
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NPI Number | 1821157371
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Entity Type | Organization
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Legal Business Name | MEDFORD SURGICAL PRACTICE
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 05/22/2009
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Provider Practice Location Address
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Address Line | 212 CREEK CROSSING BLVD
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City | HAINESPORT
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State | NJ
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Zip | 08036-2766
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Country | US
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Telephone | 609-267-1004
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Fax | 609-267-1044
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Provider Business Mailing Address
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Address Line | 212 CREEK CROSSING BLVD
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City | HAINESPORT
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State | NJ
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Zip | 08036-2766
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Country | US
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Telephone | 609-267-1004
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Fax | 609-267-1044
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TARA L KOWALEWSKI
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Credential |
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Telephone | 856-753-0913
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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 |
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License Number State |
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