Provider Demographics
NPI:1326008640
Name:OMSCNJ SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:OMSCNJ SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CHEIFETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-587-2900
Mailing Address - Street 1:2303 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1931
Mailing Address - Country:US
Mailing Address - Phone:609-587-2900
Mailing Address - Fax:609-587-1749
Practice Address - Street 1:2303 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1931
Practice Address - Country:US
Practice Address - Phone:609-587-2900
Practice Address - Fax:609-587-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD10747261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ004423Medicare PIN
NJW8844Medicare UPIN