Provider Demographics
NPI:1013921964
Name:BLOOMFIELD SURGI-CENTER, LLC
Entity Type:Organization
Organization Name:BLOOMFIELD SURGI-CENTER, LLC
Other - Org Name:DBA AMBULATORY CENTER OF EXCELLENCE IN SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:973-842-2150
Mailing Address - Street 1:1255 BROAD STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3061
Mailing Address - Country:US
Mailing Address - Phone:973-842-2150
Mailing Address - Fax:973-338-3545
Practice Address - Street 1:1255 BROAD STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3061
Practice Address - Country:US
Practice Address - Phone:973-842-2150
Practice Address - Fax:973-338-3545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23459261QA1903X
23459261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ103550Medicare PIN
NJ103550Medicare PIN