Provider Demographics
NPI:1386000529
Name:ALLIANCE SURGERY CENTER
Entity Type:Organization
Organization Name:ALLIANCE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIKE
Authorized Official - Middle Name:W
Authorized Official - Last Name:OBIANWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-764-7660
Mailing Address - Street 1:412 CREEK CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2768
Mailing Address - Country:US
Mailing Address - Phone:856-764-7660
Mailing Address - Fax:856-764-5723
Practice Address - Street 1:412 CREEK CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2768
Practice Address - Country:US
Practice Address - Phone:856-764-7660
Practice Address - Fax:856-764-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJR24898261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical