1013143007 NPI number — HARRISON ENDO 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 1013143007 NPI number — HARRISON ENDO SURGICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRISON ENDO 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:
Provider Other Organization Name Type Code:
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:
1013143007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 ESSEX ST STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07029-2134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-474-1040
Provider Business Mailing Address Fax Number:
973-474-1030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 ESSEX ST
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
HARRISON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07029-2134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-713-2420
Provider Business Practice Location Address Fax Number:
973-942-3295
Provider Enumeration Date:
06/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
973-474-1040

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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