Provider Demographics
NPI:1679897623
Name:FAIR LAWN ASC LLC
Entity Type:Organization
Organization Name:FAIR LAWN ASC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-433-4447
Mailing Address - Street 1:15-01 POLLITT DR
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2769
Mailing Address - Country:US
Mailing Address - Phone:516-433-4447
Mailing Address - Fax:516-433-4447
Practice Address - Street 1:15-01 POLLITT DR
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2769
Practice Address - Country:US
Practice Address - Phone:516-433-4447
Practice Address - Fax:516-433-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical