Healthcare Provider Details

I. General information

NPI: 1508730508
Provider Name (Legal Business Name): JAMES STREET SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 JAMES ST
EDISON NJ
08820-3946
US

IV. Provider business mailing address

121 JAMES ST
EDISON NJ
08820-3946
US

V. Phone/Fax

Practice location:
  • Phone: 469-872-4706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JONATHAN BAILEY
Title or Position: OFFICER/AO
Credential:
Phone: 203-609-1168