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NPI Code Detail

MEDICARE: SCOB, LLC

MEDICARE: SCOB, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1639689250
Entity Type Code : Organization
Provider Name (Legal Business Name) : SCOB, LLC
Provider Business Mailing Address
First Line : 190 MIDLAND AVE FL 2
Second Line :
City : SADDLE BROOK
State : NJ
Zip : 07663-6408
Country : US
Telephone Number : 201-549-9998
Fax Number : 646-585-4251
Provider Business Practice Location Address
First Line : 313 43RD ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11232-3609
Country : US
Telephone Number : 718-369-4800
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : SONA GARDELLA
Credential :
Telephone Number : 201-549-9998
Provider Enumeration Date : 10/10/2017
Last Update Date : 06/21/2021

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Directions to “SCOB, LLC ” Practice Location

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