Provider Demographics
NPI:1740261882
Name:ENDO SURGICAL CENTER OF NORTH JERSEY
Entity type:Organization
Organization Name:ENDO SURGICAL CENTER OF NORTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOCAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-777-7879
Mailing Address - Street 1:999 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2711
Mailing Address - Country:US
Mailing Address - Phone:973-777-3938
Mailing Address - Fax:
Practice Address - Street 1:999 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2711
Practice Address - Country:US
Practice Address - Phone:973-777-3938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22847261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311053Medicare ID - Type Unspecified
NJ311053Medicare PIN
311053Medicare PIN