Healthcare Provider Details

I. General information

NPI: 1780737239
Provider Name (Legal Business Name): SURGICARE SURGICAL ASSOCIATES OF CARLSTADT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 BROAD ST
CARLSTADT NJ
07072-1169
US

IV. Provider business mailing address

630 BROAD ST
CARLSTADT NJ
07072-1169
US

V. Phone/Fax

Practice location:
  • Phone: 201-355-1700
  • Fax: 201-355-1694
Mailing address:
  • Phone: 201-355-1700
  • Fax: 201-355-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KEVIN BASRALIAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 201-355-1700