=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841353737
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED LAPAROSCOPIC ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 81RTE. 4W. 35 PLAZA PROFESSIONAL CENTER, SUITE 401
-----------------------------------------------------
City | PARAMUS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07652-0058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-646-1121
-----------------------------------------------------
Fax | 201-646-1110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 81 E RTE 4 35 PLAZA PROFESSIONAL CENTER, SUITE 401
-----------------------------------------------------
City | PARAMUS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07652-2634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-646-1121
-----------------------------------------------------
Fax | 201-646-1110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | KATHLEEN M CONNOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-646-1121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------