1770847717 NPI number — ENDOSCOPY CENTER OF HACKENSACK, LLC

Table of content: MS. DEANNA JOAN ROSSER LMSW (NPI 1346300654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770847717 NPI number — ENDOSCOPY CENTER OF HACKENSACK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOSCOPY CENTER OF HACKENSACK, 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:
Provider Other Organization Name Type Code:
6
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:
1770847717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14201 DALLAS PKWY STE 1600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75254-2916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 PROSPECT AVE
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-489-0030
Provider Business Practice Location Address Fax Number:
201-708-6300
Provider Enumeration Date:
06/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED SIGNER/OFFICER
Authorized Official Telephone Number:
203-609-1168

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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