Provider Demographics
NPI:1962644906
Name:JOURNAL SQUARE SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:JOURNAL SQUARE SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DI NARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-795-0205
Mailing Address - Street 1:550 NEWARK AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1326
Mailing Address - Country:US
Mailing Address - Phone:201-795-0205
Mailing Address - Fax:
Practice Address - Street 1:550 NEWARK AVE
Practice Address - Street 2:UNITS 501, 408 AND 103
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1326
Practice Address - Country:US
Practice Address - Phone:201-795-0205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
166333Medicare PIN