Basic Information
| Provider Information | |||||||||
| NPI: | 1104883990 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGICARE AMBULATORY CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3250 WESTCHESTER AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104614500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185189000 | ||||||||
| FaxNumber: | 7185180495 | ||||||||
| Practice Location | |||||||||
| Address1: | 3250 WESTCHESTER AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104614500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185189000 | ||||||||
| FaxNumber: | 7185180495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 04/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | BUFFA | ||||||||
| AuthorizedOfficialFirstName: | SALVATORE | ||||||||
| AuthorizedOfficialMiddleName: | DANIEL | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7185189000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 7000253R | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 01911619 | 05 | NY | MEDICAID |