Healthcare Provider Details

I. General information

NPI: 1194935577
Provider Name (Legal Business Name): MILLENNIUM SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 SPRINGDALE RD STE A
CHERRY HILL NJ
08003-2024
US

IV. Provider business mailing address

14201 DALLAS PKWY
DALLAS TX
75254-2916
US

V. Phone/Fax

Practice location:
  • Phone: 856-751-4555
  • Fax: 856-751-4556
Mailing address:
  • Phone: 856-751-4555
  • Fax: 856-751-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number24172
License Number StateNJ

VIII. Authorized Official

Name: JONATHAN BAILEY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 203-609-1168