Provider Demographics
NPI:1912239062
Name:ATLANTIC SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:ATLANTIC SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-975-8365
Mailing Address - Street 1:850 S ATLANTIC BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6704
Mailing Address - Country:US
Mailing Address - Phone:626-570-8934
Mailing Address - Fax:626-284-2454
Practice Address - Street 1:850 S ATLANTIC BLVD STE 104
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6704
Practice Address - Country:US
Practice Address - Phone:626-570-8934
Practice Address - Fax:213-377-5738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-30
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF1964Medicare PIN