Affinity Surgical Associates, LLC

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

MA067801 Issued in NJ

Legal business name

AFFINITY SURGICAL ASSOCIATES, LLC

Practice address

205 Homestead Rd
Paramus, NJ 07652-4709

Phone

(516) 587-3406

NPI assigned

Jul 11, 2016

Last updated

Oct 18, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tony Jacob, P.A.NPI 1396096236

Title

President

Phone

(516) 587-3406

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tony Jacob, PA-C

  • Physician Assistant
  • Paramus, NJ
  • NPI 1396096236
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1468195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1962854232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 HOMESTEAD RD",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "076524709",
            "telephone_number": "516-587-3406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 HOMESTEAD RD",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "076524709",
            "telephone_number": "516-587-3406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFINITY SURGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-11",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-587-3406",
        "authorized_official_credential": "P.A."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NJ",
            "license": "MA067801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neurological Surgery Physician in Paramus, NJ
• Providers in Paramus, NJ by specialty
• Neurological Surgery Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; 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.