Provider Demographics
NPI:1669612990
Name:TRI-STATE SURGERY CENTER LLC
Entity type:Organization
Organization Name:TRI-STATE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-546-1890
Mailing Address - Street 1:3 WINSLOW PL
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2709
Mailing Address - Country:US
Mailing Address - Phone:201-546-1890
Mailing Address - Fax:201-546-1893
Practice Address - Street 1:3 WINSLOW PL
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2709
Practice Address - Country:US
Practice Address - Phone:201-546-1890
Practice Address - Fax:201-546-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06848500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical