Healthcare Provider Details

I. General information

NPI: 1649584806
Provider Name (Legal Business Name): SURGICARE OF BOCA RATON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CLINT MOORE RD
BOCA RATON FL
33496-2658
US

IV. Provider business mailing address

555 KINDERKAMACK RD
ORADELL NJ
07649-1517
US

V. Phone/Fax

Practice location:
  • Phone: 201-834-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN HAJJAR
Title or Position: CEO
Credential:
Phone: 201-834-1100