Heritage Surgical Group, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

25MA08710300 Issued in NJ

Legal business name

HERITAGE SURGICAL GROUP, LLC

Practice address

741 Teaneck Rd
Suite B
Teaneck, NJ 07666-4243

Phone

(201) 833-2888

Fax

(201) 833-1010

NPI assigned

Aug 29, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stavros Christoudias, M.D.NPI 1679710875

Title

Member

Phone

(201) 833-2888

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stavros George Christoudias, M.D.

  • Surgery Physician
  • Teaneck, NJ
  • NPI 1679710875
  Medicare reassignment Care Compare group NPD Authorized official
• Alison Elizabeth Dripchak, M.S., PA-C

  • Physician Assistant
  • Teaneck, NJ
  • NPI 1760937866
  Medicare reassignment Care Compare group
• Julie Zavadenko Apn LLC

  • Adult Health Nurse Practitioner
  • River Vale, NJ
  • NPI 1013306786
  Medicare reassignment NPD
• Phillip D Rose, PA-C

  • Physician Assistant
  • Teaneck, NJ
  • NPI 1205021060
  Medicare reassignment
• Leonard Vander Horn, PA

  • Surgical Physician Assistant
  • Morristown, NJ
  • NPI 1437262391
  Medicare reassignment
• Steven Waxenbaum, MD

  • Surgery Physician
  • Englewood, NJ
  • NPI 1952373466
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377734400000",
    "number": "1346674090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 TEANECK RD",
            "address_2": "SUITE B",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664243",
            "telephone_number": "201-833-2888",
            "fax_number": "201-833-1010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 TEANECK RD",
            "address_2": "SUITE B",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664243",
            "telephone_number": "201-833-2888",
            "fax_number": "201-833-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE SURGICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-29",
        "last_updated": "2013-08-29",
        "status": "A",
        "authorized_official_last_name": "CHRISTOUDIAS",
        "authorized_official_first_name": "STAVROS",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "201-833-2888",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "NJ",
            "license": "25MA08710300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nia Henderson, LCSW
• Terry W Hensle, M.D, LLC
• Lacey M Herald, PA
• Heritage Breast Care LLC
• Heritage General and Colorectal Surgery, PA
• Kevin Herman, M.D.
• Hitandewy J Hernandez-Herrera
• Iris Nereyda Hernandez, BCBA
• Ryan Hernandez, APN
• Daniel Herrmann, PSYD

• Surgery Physician in Teaneck, NJ
• Providers in Teaneck, NJ by specialty
• Surgery Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.