Provider Demographics
NPI:1487044889
Name:SOMERSET OUTPATIENT SURGERY, LLC
Entity Type:Organization
Organization Name:SOMERSET OUTPATIENT SURGERY, LLC
Other - Org Name:RARITAN VALLEY PAIN MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KASSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MROZOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-846-6101
Mailing Address - Street 1:303 GEORGE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2020
Mailing Address - Country:US
Mailing Address - Phone:732-846-6101
Mailing Address - Fax:732-846-1355
Practice Address - Street 1:303 GEORGE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2020
Practice Address - Country:US
Practice Address - Phone:732-846-6101
Practice Address - Fax:732-846-1355
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOMERSET OUTPATIENT SURGERY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-23
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09596800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty