Provider Demographics
NPI:1548791593
Name:BRIDGEWATER AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:BRIDGEWATER AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CLEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN CNOR CASC
Authorized Official - Phone:908-237-4146
Mailing Address - Street 1:1121 US HIGHWAY 22
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2982
Mailing Address - Country:US
Mailing Address - Phone:908-237-4146
Mailing Address - Fax:
Practice Address - Street 1:1121 US HIGHWAY 22
Practice Address - Street 2:SUITE 301
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2982
Practice Address - Country:US
Practice Address - Phone:908-237-4146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical