Provider Demographics
NPI:1104264555
Name:PINNACLE ENT ALLIANCE OF NEW JERSEY LLC
Entity type:Organization
Organization Name:PINNACLE ENT ALLIANCE OF NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:I
Authorized Official - Last Name:SURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-902-6092
Mailing Address - Street 1:994 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:SUITE 1017
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1802
Mailing Address - Country:US
Mailing Address - Phone:610-902-6092
Mailing Address - Fax:610-902-6081
Practice Address - Street 1:2835 S DELSEA DR
Practice Address - Street 2:SUITE D
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7056
Practice Address - Country:US
Practice Address - Phone:856-205-0800
Practice Address - Fax:856-205-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty