Basic Information
| Provider Information | |||||||||
| NPI: | 1902905607 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BERGEN PASSAIC AMBULATORY SURGERY CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1084 MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070112330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734734040 | ||||||||
| FaxNumber: | 9734722451 | ||||||||
| Practice Location | |||||||||
| Address1: | 1084 MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070112330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734734040 | ||||||||
| FaxNumber: | 9734722451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 09/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | VARGAS | ||||||||
| AuthorizedOfficialFirstName: | THERESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | C.E.O | ||||||||
| AuthorizedOfficialTelephone: | 2018386060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.