Healthcare Provider Details

I. General information

NPI: 1780630251
Provider Name (Legal Business Name): SPECIALIZED SURGICAL CENTER OF CENTRAL NEW JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/24/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 ARTHUR ST
EAST BRUNSWICK NJ
08816-3712
US

IV. Provider business mailing address

41 ARTHUR ST
EAST BRUNSWICK NJ
08816-3712
US

V. Phone/Fax

Practice location:
  • Phone: 732-828-5900
  • Fax: 732-828-0290
Mailing address:
  • Phone: 732-828-5900
  • Fax: 732-828-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN J GORDON
Title or Position: PRESIDENT
Credential: MD
Phone: 732-828-5900