Provider Demographics
NPI:1124304258
Name:SURGICAL SPECIALTIES OF NEW JERSEY, LLC
Entity type:Organization
Organization Name:SURGICAL SPECIALTIES OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BIAGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-584-1560
Mailing Address - Street 1:PO BOX 3204
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-0204
Mailing Address - Country:US
Mailing Address - Phone:609-584-1560
Mailing Address - Fax:
Practice Address - Street 1:1445 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-3834
Practice Address - Country:US
Practice Address - Phone:609-584-1560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06598500208G00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty