MEDICARE: MED-SURG PRACTITIONERS, 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	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1922419654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED-SURG PRACTITIONERS, LLC

Provider Business Mailing Address
First Line	:	85 HARRISTOWN RD
Second Line	:	SUITE 201
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-3307
Country	:	US
Telephone Number	:	201-855-8302
Fax Number	:	201-444-3925

Provider Business Practice Location Address
First Line	:	85 HARRISTOWN RD
Second Line	:	SUITE 201
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-3307
Country	:	US
Telephone Number	:	201-855-8302
Fax Number	:	201-444-3925

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN H. HAJJAR
Credential	:	M.D.
Telephone Number	:	201-855-8302

Provider Enumeration Date	:	05/15/2014
Last Update Date	:	05/15/2014

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