Provider Demographics
NPI:1730411711
Name:SURGICAL ONCOLOGY LAPAROSCOPY,PA
Entity type:Organization
Organization Name:SURGICAL ONCOLOGY LAPAROSCOPY,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:CHRISTOS
Authorized Official - Last Name:CHRISTOUDIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-833-2888
Mailing Address - Street 1:741 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4243
Mailing Address - Country:US
Mailing Address - Phone:201-833-2888
Mailing Address - Fax:201-833-1010
Practice Address - Street 1:741 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4243
Practice Address - Country:US
Practice Address - Phone:201-833-2888
Practice Address - Fax:201-833-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
25MA033190002086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ460722OtherPTAN