Provider Demographics
NPI:1235600701
Name:CITIMED SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CITIMED SURGERY CENTER, LLC
Other - Org Name:CMSC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-549-9998
Mailing Address - Street 1:9212 165TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-1104
Mailing Address - Country:US
Mailing Address - Phone:201-549-9998
Mailing Address - Fax:646-585-4251
Practice Address - Street 1:9212 165TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-1104
Practice Address - Country:US
Practice Address - Phone:718-571-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical