Basic Information
| Provider Information | |||||||||
| NPI: | 1629634761 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTIC GASTRO SURGICENTER, LLC | ||||||||
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| OtherOrganizationName: | ACCESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 YORK RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | JAMISON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189291098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155899024 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3205 FIRE RD STE 3 | ||||||||
| Address2: | |||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094071113 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2019 | ||||||||
| LastUpdateDate: | 01/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOHLFELD | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 6094071113 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QI0500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy |
No ID Information.