Provider Demographics
NPI:1144340001
Name:ADVANCED LAPAROSCOPIC SURGICAL
Entity type:Organization
Organization Name:ADVANCED LAPAROSCOPIC SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-447-2809
Mailing Address - Street 1:61 N MAPLE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3255
Mailing Address - Country:US
Mailing Address - Phone:201-447-2808
Mailing Address - Fax:
Practice Address - Street 1:61 N MAPLE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3255
Practice Address - Country:US
Practice Address - Phone:201-447-2808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty