Provider Demographics
NPI:1043441819
Name:ALC SURGICAL SERVICES LLC
Entity Type:Organization
Organization Name:ALC SURGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA LIZA
Authorized Official - Middle Name:N
Authorized Official - Last Name:CRISTOBAL
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:973-957-0551
Mailing Address - Street 1:30 W CENTURY RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1433
Mailing Address - Country:US
Mailing Address - Phone:201-986-1003
Mailing Address - Fax:201-986-1680
Practice Address - Street 1:20 HENRIETTA DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004
Practice Address - Country:US
Practice Address - Phone:973-957-0551
Practice Address - Fax:866-329-0698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11414700163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty