Provider Demographics
NPI:1235178146
Name:SUBURBAN ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:SUBURBAN ENDOSCOPY CENTER, LLC
Other - Org Name:SUBURBAN ENDOSCOPY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICARE AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3859
Mailing Address - Street 1:799 BLOOMFIELD AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1301
Mailing Address - Country:US
Mailing Address - Phone:973-571-1600
Mailing Address - Fax:973-571-1882
Practice Address - Street 1:799 BLOOMFIELD AVE
Practice Address - Street 2:STE 101
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1301
Practice Address - Country:US
Practice Address - Phone:973-571-1600
Practice Address - Fax:973-571-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22335261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31C0001162Medicare Oscar/Certification
071545Medicare PIN