MEDICARE: NORTHEAST SURGICAL SPECIALISTS OF NJ PC

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
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1780555060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST SURGICAL SPECIALISTS OF NJ PC

Provider Business Mailing Address
First Line	:	40 BERRY HILL RD
Second Line	:
City	:	OYSTER BAY
State	:	NY
Zip	:	11771-3515
Country	:	US
Telephone Number	:	718-626-0707
Fax Number	:	718-545-0333

Provider Business Practice Location Address
First Line	:	140 SYLVAN AVE STE 213
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2559
Country	:	US
Telephone Number	:	718-626-0707
Fax Number	:	718-545-0333

Authorized Official
Title or Position	:	OWNER
Name	:	PANAGIOTIS MANOLAS
Credential	:	MD
Telephone Number	:	718-626-0707

Provider Enumeration Date	:	09/17/2025
Last Update Date	:	12/12/2025

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