Provider Demographics
NPI:1336112200
Name:MERCER COUNTY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:MERCER COUNTY SURGERY CENTER LLC
Other - Org Name:MERCER COUNTY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINBART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-895-0290
Mailing Address - Street 1:2A PRINCESS ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-895-0290
Mailing Address - Fax:609-895-0291
Practice Address - Street 1:2A PRINCESS ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:609-895-0290
Practice Address - Fax:609-895-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23047261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31-C0001139Medicare Oscar/Certification
NJ052282Medicare PIN