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Organization
ENDOSURGICAL MD PA
Active
Organization
ENDOSURGICAL MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUAN DE LA CRUZ M.D. (MEDICAL DIRECTOR)
(973) 779-5554
Entity
Organization
Contact information
Practice address
335 PASSAIC ST, PASSAIC, NJ 07055-5818
(973) 779-5554
Mailing address
48 VIRVICKAS STREET, WOODLAND PARK, NJ 07424-0000
(973) 779-5554
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
25MA45725
NJ
208D00000X
General Practice Physician
Primary
25MA45725
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4011902
—
NJ
Enumeration date
03/09/2007
Last updated
02/04/2011
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