Provider Demographics
NPI:1487876769
Name:ASSOCIATED SURGEONS OF NORTHERN NEW JERSEY
Entity type:Organization
Organization Name:ASSOCIATED SURGEONS OF NORTHERN NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DVIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-567-3999
Mailing Address - Street 1:25 ROCKWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4957
Mailing Address - Country:US
Mailing Address - Phone:201-567-3999
Mailing Address - Fax:201-567-9288
Practice Address - Street 1:25 ROCKWOOD PL
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4957
Practice Address - Country:US
Practice Address - Phone:201-567-3999
Practice Address - Fax:201-567-9288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311065Medicare ID - Type Unspecified