Basic Information
| Provider Information | |||||||||
| NPI: | 1275566473 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AAA COMMUNITY SURGICAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4686 | ||||||||
| Address2: | 1390 RT 37 WEST | ||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087544686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323492990 | ||||||||
| FaxNumber: | 7325054450 | ||||||||
| Practice Location | |||||||||
| Address1: | 163 RTE 37 W | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087558046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323492990 | ||||||||
| FaxNumber: | 7325054450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 12/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | FRIED | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7323492990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335E00000X | N | Suppliers | Prosthetic/Orthotic Supplier | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BX2000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 333600000X | 28RS00211800 | NJ | Y | Suppliers | Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 4265904 | 05 | NJ | MEDICAID | 3117961 | 01 | NABP | OTHER |