Provider Demographics
NPI:1558341032
Name:SOUTH JERSEY SURGICENTER, INC
Entity Type:Organization
Organization Name:SOUTH JERSEY SURGICENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-696-0020
Mailing Address - Street 1:2835 S DELSEA DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-7079
Mailing Address - Country:US
Mailing Address - Phone:856-696-0020
Mailing Address - Fax:856-205-0300
Practice Address - Street 1:2835 S DELSEA DR
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7079
Practice Address - Country:US
Practice Address - Phone:856-696-0020
Practice Address - Fax:856-205-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311404Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER