Provider Demographics
NPI:1043384704
Name:AMBULATORY SURGERY CENTER AT OLD BRIDGE LLC
Entity Type:Organization
Organization Name:AMBULATORY SURGERY CENTER AT OLD BRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-553-9222
Mailing Address - Street 1:400 PERRINE RD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2843
Mailing Address - Country:US
Mailing Address - Phone:732-533-9222
Mailing Address - Fax:732-553-9227
Practice Address - Street 1:400 PERRINE RD
Practice Address - Street 2:SUITE 408
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2843
Practice Address - Country:US
Practice Address - Phone:732-533-9222
Practice Address - Fax:732-553-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22900261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ055997Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID