Provider Demographics
NPI:1699704536
Name:NORTH JERSEY SURGICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:NORTH JERSEY SURGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:W
Authorized Official - Last Name:TYRAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:201-444-4412
Mailing Address - Street 1:145 PROSPECT STREET
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-444-4412
Mailing Address - Fax:201-444-6966
Practice Address - Street 1:145 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4493
Practice Address - Country:US
Practice Address - Phone:201-444-4412
Practice Address - Fax:201-444-6966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA01903174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherEIN
NJ=========OtherEIN