Provider Demographics
NPI:1215079587
Name:ADVANCED LAPAROSCOPIC SURGICAL SPECIALISTS
Entity type:Organization
Organization Name:ADVANCED LAPAROSCOPIC SURGICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KEMPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-624-4425
Mailing Address - Street 1:445 ROUTE 304
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1614
Mailing Address - Country:US
Mailing Address - Phone:845-624-4425
Mailing Address - Fax:845-624-4428
Practice Address - Street 1:445 ROUTE 304
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-1614
Practice Address - Country:US
Practice Address - Phone:845-624-4425
Practice Address - Fax:845-624-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2601545Medicaid
NYH95164Medicare UPIN
NYI21099Medicare UPIN
NYI07200Medicare UPIN
NY3584H1Medicare ID - Type Unspecified
NY3543H1Medicare ID - Type Unspecified
NY0450U1Medicare ID - Type Unspecified