Provider Demographics
NPI:1639703895
Name:PERFORMANCE SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:PERFORMANCE SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-203-1835
Mailing Address - Street 1:2050 LAKEVILLE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1639
Mailing Address - Country:US
Mailing Address - Phone:516-775-8605
Mailing Address - Fax:
Practice Address - Street 1:1084 MAIN AVE FL 2
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2330
Practice Address - Country:US
Practice Address - Phone:973-473-4040
Practice Address - Fax:516-775-8618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty