Provider Demographics
NPI:1558665331
Name:ISELIN SURGICARE LLC
Entity type:Organization
Organization Name:ISELIN SURGICARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIGNESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-283-1171
Mailing Address - Street 1:1195 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2037
Mailing Address - Country:US
Mailing Address - Phone:732-283-1711
Mailing Address - Fax:732-283-1733
Practice Address - Street 1:1195 GREEN ST
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2037
Practice Address - Country:US
Practice Address - Phone:732-283-1711
Practice Address - Fax:732-283-1733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:937 SOUTH WOOD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-07
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6521540001Medicare NSC