Basic Information
| Provider Information | |||||||||
| NPI: | 1427113265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUR | ||||||||
| FirstName: | SALLY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PAC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HUR SHAFFER | ||||||||
| OtherFirstName: | SALLY | ||||||||
| OtherMiddleName: | M | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | PAC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 MADISON AVE | ||||||||
| Address2: | MID ATLANTIC SURGICAL ASSOC | ||||||||
| City: | MORRISTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739717300 | ||||||||
| FaxNumber: | 9739847019 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 MADISON AVE | ||||||||
| Address2: | SUITE 201 MID ATLANTIC SURGICAL ASSOC | ||||||||
| City: | MORRISTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739717300 | ||||||||
| FaxNumber: | 9739847019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2006 | ||||||||
| LastUpdateDate: | 03/24/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | MP00105200 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | 25MP00105200 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | 25MP001052 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.