Provider Demographics
NPI:1093867830
Name:SURGICARE SURGICAL ASSOCIATES OF FAIRLAWN, LLC
Entity Type:Organization
Organization Name:SURGICARE SURGICAL ASSOCIATES OF FAIRLAWN, LLC
Other - Org Name:SURGICARE OF FAIRLAWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-834-1100
Mailing Address - Street 1:85 HARRISTOWN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3323
Mailing Address - Country:US
Mailing Address - Phone:201-834-1100
Mailing Address - Fax:201-599-8338
Practice Address - Street 1:15-01 BROADWAY
Practice Address - Street 2:STE 1
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6003
Practice Address - Country:US
Practice Address - Phone:201-703-8487
Practice Address - Fax:201-971-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ418130Medicare PIN
NJ311045Medicare PIN