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NPI Code Detail

MEDICARE: MINIMALLY INVASIVE SURGERY CENTER, P.A.

MEDICARE: MINIMALLY INVASIVE SURGERY CENTER, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/CenterNJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10001498000OTHERNJAMERIHEALTH PROVIDER ID
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3311127OTHERNJHORIZON PROVIDER ID

General Provider Information

NPI Number : 1366498347
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINIMALLY INVASIVE SURGERY CENTER, P.A.
Provider Business Mailing Address
First Line : 1801 NEW RD
Second Line :
City : LINWOOD
State : NJ
Zip : 08221-1036
Country : US
Telephone Number : 609-653-3055
Fax Number : 609-653-8469
Provider Business Practice Location Address
First Line : 1801 NEW RD
Second Line :
City : LINWOOD
State : NJ
Zip : 08221-1036
Country : US
Telephone Number : 609-653-3055
Fax Number : 609-653-8469
Authorized Official
Title or Position : CFO
Name : DR. BURHAN HALEEM
Credential : DO
Telephone Number : 855-727-2465
Provider Enumeration Date : 05/25/2006
Last Update Date : 12/07/2022

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