Provider Demographics
NPI:1316071178
Name:GENERAL SURGERY PRACTICE, LLC
Entity type:Organization
Organization Name:GENERAL SURGERY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SHIKIAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-541-7940
Mailing Address - Street 1:140 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-6581
Mailing Address - Country:US
Mailing Address - Phone:201-541-7940
Mailing Address - Fax:201-541-7942
Practice Address - Street 1:140 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-6581
Practice Address - Country:US
Practice Address - Phone:201-541-7940
Practice Address - Fax:201-541-7942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5594006Medicaid
NJF67474Medicare UPIN
NJ099770Medicare ID - Type Unspecified