Provider Demographics
NPI:1780737239
Name:SURGICARE SURGICAL ASSOCIATES OF CARLSTADT, LLC
Entity type:Organization
Organization Name:SURGICARE SURGICAL ASSOCIATES OF CARLSTADT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASRALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-355-1700
Mailing Address - Street 1:630 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CARLSTADT
Mailing Address - State:NJ
Mailing Address - Zip Code:07072-1169
Mailing Address - Country:US
Mailing Address - Phone:201-355-1700
Mailing Address - Fax:201-355-1964
Practice Address - Street 1:630 BROAD ST
Practice Address - Street 2:
Practice Address - City:CARLSTADT
Practice Address - State:NJ
Practice Address - Zip Code:07072-1169
Practice Address - Country:US
Practice Address - Phone:201-355-1700
Practice Address - Fax:201-355-1694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical