Basic Information
| Provider Information | |||||||||
| NPI: | 1356533624 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGAIDE 2 LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4059 | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074744059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738268287 | ||||||||
| FaxNumber: | 9735136081 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 ROUTE 46 W | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074706830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738268287 | ||||||||
| FaxNumber: | 9735136081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2007 | ||||||||
| LastUpdateDate: | 02/17/2011 | ||||||||
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| AuthorizedOfficialLastName: | VOSOUGH | ||||||||
| AuthorizedOfficialFirstName: | KHASHAYAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9738268287 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.