Provider Demographics
NPI:1164118147
Name:SAMWELL SURGICAL
Entity Type:Organization
Organization Name:SAMWELL SURGICAL
Other - Org Name:ENGLEWOOD CLIFFS SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-827-7249
Mailing Address - Street 1:520 SYLVAN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-3062
Mailing Address - Country:US
Mailing Address - Phone:732-943-7703
Mailing Address - Fax:
Practice Address - Street 1:520 SYLVAN AVE STE 102
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-3062
Practice Address - Country:US
Practice Address - Phone:732-943-7703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical