Provider Demographics
NPI:1811389976
Name:AMBULATORY SURGICAL CENTER OF ENGLEWOOD LLC
Entity Type:Organization
Organization Name:AMBULATORY SURGICAL CENTER OF ENGLEWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-678-0079
Mailing Address - Street 1:2309 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-8103
Mailing Address - Country:US
Mailing Address - Phone:347-284-4500
Mailing Address - Fax:347-284-4982
Practice Address - Street 1:25 ROCKWOOD PL
Practice Address - Street 2:SUITE 105
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4957
Practice Address - Country:US
Practice Address - Phone:917-678-0079
Practice Address - Fax:347-284-4982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical