=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962309088
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN SURGICAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2026
-----------------------------------------------------
Last Update Date | 10/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 HOOPER AVE STE B
-----------------------------------------------------
City | TOMS RIVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08753-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-733-6018
-----------------------------------------------------
Fax | 732-733-6018
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 TINDALL RD
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07748-2321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-733-6018
-----------------------------------------------------
Fax | 732-733-6018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | BRANKO SKOVRLJ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 917-881-3023
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------