Provider Demographics
NPI:1366441024
Name:WEST PARKWAY AMBULATORY SURGERY
Entity Type:Organization
Organization Name:WEST PARKWAY AMBULATORY SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:EZERSKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-831-5461
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-0515
Mailing Address - Country:US
Mailing Address - Phone:973-831-5461
Mailing Address - Fax:973-831-5203
Practice Address - Street 1:97 W PARKWAY
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1647
Practice Address - Country:US
Practice Address - Phone:973-831-5461
Practice Address - Fax:973-831-5203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23218261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083902Medicare PIN
NJ31C0001169Medicare NSC