Provider Demographics
NPI:1639689250
Name:SCOB, LLC
Entity Type:Organization
Organization Name:SCOB, LLC
Other - Org Name:SURGICARE OF BROOKLYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SONA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-549-9998
Mailing Address - Street 1:190 MIDLAND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-6408
Mailing Address - Country:US
Mailing Address - Phone:201-549-9998
Mailing Address - Fax:646-585-4251
Practice Address - Street 1:313 43RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-3609
Practice Address - Country:US
Practice Address - Phone:718-369-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical