Provider Demographics
NPI:1609390459
Name:WEST ORANGE SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:WEST ORANGE SURGICAL CENTER, LLC
Other - Org Name:MOUNTAIN SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TRICOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-947-3080
Mailing Address - Street 1:652 PALM SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7838
Mailing Address - Country:US
Mailing Address - Phone:407-332-9871
Mailing Address - Fax:
Practice Address - Street 1:375 MOUNT PLEASANT AVE STE 210
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2751
Practice Address - Country:US
Practice Address - Phone:973-736-3390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24393261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical