Provider Demographics
NPI:1902863723
Name:OAK & MAIN SURGICENTER LLC
Entity Type:Organization
Organization Name:OAK & MAIN SURGICENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS, FCCP, RVT
Authorized Official - Phone:856-692-7228
Mailing Address - Street 1:907 N MAIN RD
Mailing Address - Street 2:BLDG C
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-8200
Mailing Address - Country:US
Mailing Address - Phone:856-692-7228
Mailing Address - Fax:856-692-4155
Practice Address - Street 1:907 N MAIN RD
Practice Address - Street 2:BLDG C
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8200
Practice Address - Country:US
Practice Address - Phone:856-692-7228
Practice Address - Fax:856-692-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22341261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0001425000OtherAMERIHEALTH
NJ311096OtherALL BLUE CROSS BLUE SHIEL
NJ962591OtherALL AETNA INSURANCES
NJ7465203Medicaid
NJ962591OtherALL AETNA INSURANCES