Provider Demographics
NPI:1184151425
Name:SURGICORE OF JERSEY CITY, LLC.
Entity type:Organization
Organization Name:SURGICORE OF JERSEY CITY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGRADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-495-5262
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
Mailing Address - Country:US
Mailing Address - Phone:201-795-0205
Mailing Address - Fax:201-795-0737
Practice Address - Street 1:550 NEWARK AVE FL 5
Practice Address - Street 2:
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:201-795-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ80193261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center