Provider Demographics
NPI:1841231792
Name:NORTH HAVEN SURGERY CENTER LLC
Entity Type:Organization
Organization Name:NORTH HAVEN SURGERY CENTER LLC
Other - Org Name:NORTH HAVEN PAIN MEDICINE CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-609-1168
Mailing Address - Street 1:52 WASHINGTON AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1724
Mailing Address - Country:US
Mailing Address - Phone:203-234-7727
Mailing Address - Fax:203-234-7114
Practice Address - Street 1:52 WASHINGTON AVE
Practice Address - Street 2:STE 1
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1724
Practice Address - Country:US
Practice Address - Phone:203-234-7727
Practice Address - Fax:203-234-7114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0306261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT490000248Medicare PIN