Provider Demographics
NPI:1285179564
Name:DYNAMIC SURGERY CENTER LLC
Entity Type:Organization
Organization Name:DYNAMIC SURGERY CENTER LLC
Other - Org Name:HACKENSACK SPECIALTY ASC, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
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 1:321 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2066
Mailing Address - Country:US
Mailing Address - Phone:201-692-9800
Mailing Address - Fax:
Practice Address - Street 1:321 ESSEX ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2066
Practice Address - Country:US
Practice Address - Phone:201-692-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical