Provider Demographics
NPI:1780630251
Name:SPECIALIZED SURGICAL CENTER OF CENTRAL NEW JERSEY, LLC
Entity Type:Organization
Organization Name:SPECIALIZED SURGICAL CENTER OF CENTRAL NEW JERSEY, LLC
Other - Org Name:SOMERSET EYE INSTITUTE, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-828-5900
Mailing Address - Street 1:41 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3712
Mailing Address - Country:US
Mailing Address - Phone:732-828-5900
Mailing Address - Fax:732-828-0290
Practice Address - Street 1:41 ARTHUR ST
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3712
Practice Address - Country:US
Practice Address - Phone:732-828-5900
Practice Address - Fax:732-828-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7465505Medicaid
NJ311071OtherHORIZON BC ID NUMBER
NJ311071OtherHORIZON BC ID NUMBER