Provider Demographics
NPI:1346416690
Name:GARDEN STATE AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:GARDEN STATE AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROTHKOPF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-341-7010
Mailing Address - Street 1:1 PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-3756
Mailing Address - Country:US
Mailing Address - Phone:732-341-7010
Mailing Address - Fax:732-341-5066
Practice Address - Street 1:1 PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3756
Practice Address - Country:US
Practice Address - Phone:732-341-7010
Practice Address - Fax:732-341-5066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ135681Medicare PIN