Provider Demographics
NPI:1851743074
Name:DELAWARE VALLEY SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:DELAWARE VALLEY SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TALIADOUROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-988-0072
Mailing Address - Street 1:6000 SAGEMORE DR
Mailing Address - Street 2:SUITE 6103
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3900
Mailing Address - Country:US
Mailing Address - Phone:856-988-0072
Mailing Address - Fax:856-988-7308
Practice Address - Street 1:6000 SAGEMORE DR
Practice Address - Street 2:SUITE 6103
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3900
Practice Address - Country:US
Practice Address - Phone:856-988-0072
Practice Address - Fax:856-988-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJR24708261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical