Provider Demographics
NPI:1821398199
Name:SPECIALTY SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:SPECIALTY SURGICAL CENTER, LLC
Other - Org Name:SPECIALTY SURGICAL CENTER ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MYKULIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-940-3166
Mailing Address - Street 1:PO BOX 95000-4525
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-4525
Mailing Address - Country:US
Mailing Address - Phone:717-263-5562
Mailing Address - Fax:717-263-1566
Practice Address - Street 1:380 LAFAYETTE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3556
Practice Address - Country:US
Practice Address - Phone:973-940-3166
Practice Address - Fax:973-940-3170
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALTY SURGICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty