Provider Demographics
NPI:1639597008
Name:AMBULATORY SURGICAL PAVILION OF NEW JERSEY
Entity Type:Organization
Organization Name:AMBULATORY SURGICAL PAVILION OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-683-3008
Mailing Address - Street 1:600 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2014
Mailing Address - Country:US
Mailing Address - Phone:973-970-8655
Mailing Address - Fax:
Practice Address - Street 1:600 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2014
Practice Address - Country:US
Practice Address - Phone:347-683-3008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical