Provider Demographics
NPI:1861804585
Name:DENVILLE SURGERY CENTER, LLC
Entity type:Organization
Organization Name:DENVILLE SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-609-1168
Mailing Address - Street 1:3130 ROUTE 10 WEST
Mailing Address - Street 2:STE 200
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-3454
Mailing Address - Country:US
Mailing Address - Phone:973-328-3475
Mailing Address - Fax:973-328-3476
Practice Address - Street 1:3130 ROUTE 10 WEST
Practice Address - Street 2:STE 200
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-3454
Practice Address - Country:US
Practice Address - Phone:973-328-3475
Practice Address - Fax:973-328-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22964261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31C0001150Medicare Oscar/Certification
NJ407059Medicare PIN