Provider Demographics
NPI:1659649549
Name:SUBURBAN ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:SUBURBAN ENDOSCOPY CENTER, LLC
Other - Org Name:UAP VERONA ENDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:799 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1367
Mailing Address - Country:US
Mailing Address - Phone:973-571-1600
Mailing Address - Fax:973-571-1882
Practice Address - Street 1:799 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1367
Practice Address - Country:US
Practice Address - Phone:973-571-1600
Practice Address - Fax:973-571-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty