Provider Demographics
NPI:1295848752
Name:ESSEX SURGICAL ARTS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ESSEX SURGICAL ARTS SURGERY CENTER, LLC
Other - Org Name:MOBILE VASCULAR PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/ CMO
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-717-1839
Mailing Address - Street 1:727 JORALEMON ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1455
Mailing Address - Country:US
Mailing Address - Phone:973-329-0380
Mailing Address - Fax:
Practice Address - Street 1:727 JORALEMON ST STE B
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1455
Practice Address - Country:US
Practice Address - Phone:973-329-0380
Practice Address - Fax:973-329-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0204X
NJNONE261QA1903X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty