1922055235 NPI number — SEIDENBERG PROTZKO SURGERY CENTER LLC

Table of content: (NPI 1922055235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922055235 NPI number — SEIDENBERG PROTZKO SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEIDENBERG PROTZKO SURGERY 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:
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:
1922055235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 MOUNTAIN AVE FL 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW PROVIDENCE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07974-2736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-458-8313
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 BEARDS HILL RD
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21001-2232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-273-9096
Provider Business Practice Location Address Fax Number:
410-273-9146
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MADREPERLA
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
908-458-8333

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1432 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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