Provider Demographics
NPI:1659505857
Name:HASBROUCK HEIGHTS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:HASBROUCK HEIGHTS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-288-6330
Mailing Address - Street 1:214 TERRACE AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1815
Mailing Address - Country:US
Mailing Address - Phone:201-288-6330
Mailing Address - Fax:201-288-6331
Practice Address - Street 1:214 TERRACE AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1815
Practice Address - Country:US
Practice Address - Phone:201-288-6330
Practice Address - Fax:201-288-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical