Provider Demographics
NPI:1033836093
Name:ALPHA AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ALPHA AMBULATORY SURGERY CENTER, LLC
Other - Org Name:ALPHA AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR OF THE BILLING D
Authorized Official - Prefix:
Authorized Official - First Name:ANNIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-319-3977
Mailing Address - Street 1:1041 3RD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8114
Mailing Address - Country:US
Mailing Address - Phone:212-319-3977
Mailing Address - Fax:
Practice Address - Street 1:110 E 60TH ST STE 404
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1694
Practice Address - Country:US
Practice Address - Phone:212-319-3977
Practice Address - Fax:212-721-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04568883Medicaid
NY00329451Medicaid
NY06077421Medicaid
NY05721540Medicaid