Provider Demographics
NPI:1689627283
Name:AMBULATORY SURGICAL CENTER OF NEW JERSEY,LLC
Entity Type:Organization
Organization Name:AMBULATORY SURGICAL CENTER OF NEW JERSEY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-EXECUTIVE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:RUSSONIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-668-4410
Mailing Address - Street 1:5 PROGRESS ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1102
Mailing Address - Country:US
Mailing Address - Phone:908-755-9671
Mailing Address - Fax:908-755-9675
Practice Address - Street 1:5 PROGRESS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1102
Practice Address - Country:US
Practice Address - Phone:908-755-9671
Practice Address - Fax:908-755-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31C0001188Medicare ID - Type Unspecified