# ENDOSURGICAL MD PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417089335
- **Authorized official:** DR. JUAN DE LA CRUZ M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (973) 779-5554

## Contact information

- **Practice address:** 335 PASSAIC ST, PASSAIC, NJ 07055-5818
- **Practice address phone:** (973) 779-5554
- **Mailing address:** 48 VIRVICKAS STREET, WOODLAND PARK, NJ 07424-0000
- **Mailing address phone:** (973) 779-5554

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | 25MA45725 | NJ | — |
| 208D00000X | General Practice Physician | 25MA45725 | NJ | Yes |

## Other

- **Enumeration date:** 03/09/2007
- **Last updated:** 02/04/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4011902 | — | NJ |