Provider Demographics
NPI:1831491117
Name:MOUNTAIN SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:MOUNTAIN SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-736-3390
Mailing Address - Street 1:375 MT. PLEASANT AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2724
Mailing Address - Country:US
Mailing Address - Phone:973-736-3390
Mailing Address - Fax:973-736-3334
Practice Address - Street 1:375 MT. PLEASANT AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2724
Practice Address - Country:US
Practice Address - Phone:973-736-3390
Practice Address - Fax:973-736-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical