Provider Demographics
NPI:1922055235
Name:SEIDENBERG PROTZKO SURGERY CENTER LLC
Entity Type:Organization
Organization Name:SEIDENBERG PROTZKO SURGERY CENTER LLC
Other - Org Name:MID ATLANTIC SURGERY PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADREPERLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:908-458-8333
Mailing Address - Street 1:420 MOUNTAIN AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-2736
Mailing Address - Country:US
Mailing Address - Phone:908-458-8313
Mailing Address - Fax:
Practice Address - Street 1:1111 BEARDS HILL RD
Practice Address - Street 2:SUITE 700
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2232
Practice Address - Country:US
Practice Address - Phone:410-273-9096
Practice Address - Fax:410-273-9146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1432261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
200ZMedicare PIN