Provider Demographics
NPI:1619245230
Name:AMBULATORY SURGICAL PAVILION AT ROBERT WOOD JOHNSON LLC
Entity Type:Organization
Organization Name:AMBULATORY SURGICAL PAVILION AT ROBERT WOOD JOHNSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-408-1460
Mailing Address - Street 1:10 PLUM STREET
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 PLUM STREET
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2066
Practice Address - Country:US
Practice Address - Phone:630-408-1460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical