Basic Information
| Provider Information | |||||||||
| NPI: | 1477210532 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGICAL NURSE ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 W SOMERDALE RD | ||||||||
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| City: | SOMERDALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080832230 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 18 E LAUREL RD | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080841327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563466000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2021 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | WARDLOW | ||||||||
| AuthorizedOfficialFirstName: | JANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | RNFA | ||||||||
| AuthorizedOfficialTelephone: | 2677841014 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.