Organization
ADVANCED LAPAROSCOPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHASHAYAR VOSOUGH M.D. (OWNER)
(973) 826-8291
Entity
Organization
Contact information
Practice address
61 N MAPLE AVE, RIDGEWOOD, NJ 07450-3255
(201) 445-7070
Mailing address
PO BOX 4737, WAYNE, NJ 07474-4737
(973) 826-8291
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA06580400
NJ
Other
Enumeration date
05/18/2009
Last updated
04/01/2011
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