Provider Demographics
NPI:1780861096
Name:ROSELAND AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ROSELAND AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIARDINO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:973-618-2200
Mailing Address - Street 1:556 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1503
Mailing Address - Country:US
Mailing Address - Phone:973-618-2200
Mailing Address - Fax:973-403-8949
Practice Address - Street 1:556 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1503
Practice Address - Country:US
Practice Address - Phone:973-618-2200
Practice Address - Fax:973-403-8949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ70785261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069225Medicare PIN