Provider Demographics
NPI:1801987805
Name:ENDO SURGI CENTER OF OLD BRIDGE LLC
Entity type:Organization
Organization Name:ENDO SURGI CENTER OF OLD BRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIAPPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTHUSAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-679-8808
Mailing Address - Street 1:42 THROCKMORTON LN
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2572
Mailing Address - Country:US
Mailing Address - Phone:732-679-8808
Mailing Address - Fax:732-679-7280
Practice Address - Street 1:42 THROCKMORTON LN
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2572
Practice Address - Country:US
Practice Address - Phone:732-679-8808
Practice Address - Fax:732-679-7280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ034961Medicare ID - Type UnspecifiedMEDICARE PROVIDER #