Provider Demographics
NPI:1346219813
Name:RIDGEWOOD AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:RIDGEWOOD AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KOPELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-444-9002
Mailing Address - Street 1:1200 E RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3957
Mailing Address - Country:US
Mailing Address - Phone:201-444-9002
Mailing Address - Fax:201-612-8114
Practice Address - Street 1:1200 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3957
Practice Address - Country:US
Practice Address - Phone:201-444-9002
Practice Address - Fax:201-612-8114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJZ03891OtherHEALTHNET
NJA1011061OtherOXFORD
NJ490002689OtherRAILROAD MEDICARE
NJ311063Medicare ID - Type Unspecified