Healthcare Provider Details

I. General information

NPI: 1134513260
Provider Name (Legal Business Name): MAIN AVENUE CLIFTON SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 MAIN AVE
CLIFTON NJ
07011-2330
US

IV. Provider business mailing address

26 THROCKMORTON LN SECOND FLOOR
OLD BRIDGE NJ
08857-2520
US

V. Phone/Fax

Practice location:
  • Phone: 973-473-4040
  • Fax:
Mailing address:
  • Phone: 732-952-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMIT POONIA
Title or Position: OWNER
Credential: M.D.
Phone: 732-952-5533