Healthcare Provider Details

I. General information

NPI: 1013921964
Provider Name (Legal Business Name): BLOOMFIELD SURGI-CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 BROAD STREET SUITE 200
BLOOMFIELD NJ
07003-3061
US

IV. Provider business mailing address

1255 BROAD STREET SUITE 200
BLOOMFIELD NJ
07003-3061
US

V. Phone/Fax

Practice location:
  • Phone: 973-842-2150
  • Fax: 973-338-3545
Mailing address:
  • Phone: 973-842-2150
  • Fax: 973-338-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number23459
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number23459
License Number State

VIII. Authorized Official

Name: MR. HENRY KILROY
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 973-842-2150