1609390459 NPI number — WEST ORANGE SURGICAL CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609390459 NPI number — WEST ORANGE SURGICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST ORANGE SURGICAL CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOUNTAIN SURGERY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609390459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
652 PALM SPRINGS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32701-7838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-332-9871
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 MOUNT PLEASANT AVE STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07052-2751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-736-3390
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
TRICOLI
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
407-947-3080

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  24393 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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