Basic Information
Provider Information
NPI: 1821242488
EntityType: 2
ReplacementNPI:  
OrganizationName: SPECIALTY SURGICAL CENTER OF NORTH BRUNSWICK, LLC
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Mailing Information
Address1: 1A BURTON HILLS BLVD
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372156187
CountryCode: US
TelephoneNumber: 6152403741
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Practice Location
Address1: 1520 US ROUTE 130 STE 103
Address2:  
City: NORTH BRUNSWICK
State: NJ
PostalCode: 089023145
CountryCode: US
TelephoneNumber: 7324229900
FaxNumber: 7324229901
Other Information
ProviderEnumerationDate: 11/10/2008
LastUpdateDate: 06/22/2021
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AuthorizedOfficialLastName: SNODGRASS
AuthorizedOfficialFirstName: JEFFREY
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AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 6156651283
IsSoleProprietor:  
IsOrganizationSubpart: N
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NPICertificationDate: 06/22/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QA1903X  Y Ambulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical

No ID Information.


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