Basic Information
| Provider Information | |||||||||
| NPI: | 1346488806 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BURLCO SURGICAL ASSIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 KATHLEEN AVE | ||||||||
| Address2: | |||||||||
| City: | CINNAMINSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080772932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568291182 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 KATHLEEN AVE | ||||||||
| Address2: | |||||||||
| City: | CINNAMINSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080772932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568291182 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2009 | ||||||||
| LastUpdateDate: | 01/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | ANGEL | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | RNFA | ||||||||
| AuthorizedOfficialTelephone: | 8568291182 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 26NR0543900 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.