Provider Demographics
NPI:1629660972
Name:WEST ORANGE ASC LLC
Entity Type:Organization
Organization Name:WEST ORANGE ASC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-240-3740
Mailing Address - Street 1:101 OLD SHORT HILLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1023
Mailing Address - Country:US
Mailing Address - Phone:973-322-6200
Mailing Address - Fax:973-322-6633
Practice Address - Street 1:101 OLD SHORT HILLS RD STE 300
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1023
Practice Address - Country:US
Practice Address - Phone:973-322-6200
Practice Address - Fax:973-322-6633
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST ORANGE ASC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty