Basic Information
| Provider Information | |||||||||
| NPI: | 1689627283 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMBULATORY SURGICAL CENTER OF NEW JERSEY,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 PROGRESS ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088201102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087559671 | ||||||||
| FaxNumber: | 9087559675 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 PROGRESS ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088201102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087559671 | ||||||||
| FaxNumber: | 9087559675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 09/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | RUSSONIELLO | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
| AuthorizedOfficialMiddleName: | PETER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT-EXECUTIVE BOARD | ||||||||
| AuthorizedOfficialTelephone: | 9086684410 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.