Basic Information
| Provider Information | |||||||||
| NPI: | 1851514335 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDIPLEX SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 JAMES ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088203938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326321571 | ||||||||
| FaxNumber: | 7326321644 | ||||||||
| Practice Location | |||||||||
| Address1: | 98 JAMES ST | ||||||||
| Address2: | STE 108 | ||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088203902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326321571 | ||||||||
| FaxNumber: | 7326321644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 11/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7323217000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 71276 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 3348008 | 05 | NJ | MEDICAID |