Provider Demographics
NPI:1922028265
Name:ATLANTIC GASTRO SURGICENTER, LLC
Entity Type:Organization
Organization Name:ATLANTIC GASTRO SURGICENTER, LLC
Other - Org Name:T/A ACCESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:SABLYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-589-9001
Mailing Address - Street 1:3205 FIRE ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5837
Mailing Address - Country:US
Mailing Address - Phone:609-407-1113
Mailing Address - Fax:609-407-7149
Practice Address - Street 1:3205 FIRE ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5837
Practice Address - Country:US
Practice Address - Phone:609-407-1113
Practice Address - Fax:609-407-7149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22935261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7248105Medicaid
148576Medicare PIN
NJ148576Medicare Oscar/Certification