Provider Demographics
NPI:1255361259
Name:CENTRAL JERSEY SURGERY CENTER LLC
Entity type:Organization
Organization Name:CENTRAL JERSEY SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3890
Mailing Address - Street 1:97 CORBETT WAY
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2264
Mailing Address - Country:US
Mailing Address - Phone:732-460-2777
Mailing Address - Fax:732-460-2787
Practice Address - Street 1:97 CORBETT WAY
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2264
Practice Address - Country:US
Practice Address - Phone:732-460-2777
Practice Address - Fax:732-460-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22649261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8182701Medicaid
NJ311118OtherHORIZON BLUE CROSS
NJ490004318OtherRAILROAD MEDICARE
NJ029816Medicare PIN
NJ311118OtherHORIZON BLUE CROSS