MEDICARE: NORTH JERSEY SURGICAL ASSISTANT SERVICES, LLC

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	163WR0006X	Registered Nurse First Assistant
2	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1881986685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH JERSEY SURGICAL ASSISTANT SERVICES, LLC

Provider Business Mailing Address
First Line	:	455 KIPP AVE
Second Line	:	FLOOR 2
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-2614
Country	:	US
Telephone Number	:	201-727-9330
Fax Number	:	201-425-4527

Provider Business Practice Location Address
First Line	:	455 KIPP AVE
Second Line	:	FLOOR 2
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-2614
Country	:	US
Telephone Number	:	201-727-9330
Fax Number	:	201-425-4527

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MICHELLE LASKI
Credential	:	BSN
Telephone Number	:	201-727-9330

Provider Enumeration Date	:	05/11/2011
Last Update Date	:	02/10/2017

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