Healthcare Provider Details

I. General information

NPI: 1194950915
Provider Name (Legal Business Name): JASPER AMBULATORY SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 BRICK BLVD BLDG 3 SUITE 121
BRICK NJ
08723-7984
US

IV. Provider business mailing address

74 BRICK BLVD. BLDG 3 SUITE 121
BRICK NJ
08723-7984
US

V. Phone/Fax

Practice location:
  • Phone: 732-262-0700
  • Fax:
Mailing address:
  • Phone: 732-262-0700
  • 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: GABRIELE P. JASPER
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 732-262-0700