Provider Demographics
NPI:1275774747
Name:CHRISTIANA SPINE AMBULATORY SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:CHRISTIANA SPINE AMBULATORY SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CUCUZZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-623-4144
Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 3302
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:302-623-4144
Mailing Address - Fax:302-623-4147
Practice Address - Street 1:1101 TWIN C LANE
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-623-4144
Practice Address - Fax:302-623-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1457480535OtherNPI #
DE1457480535OtherNPI #
DEH93131Medicare UPIN
H93131Medicare UPIN
DEG34701Medicare UPIN