Healthcare Provider Details

I. General information

NPI: 1922028265
Provider Name (Legal Business Name): ATLANTIC GASTRO SURGICENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 FIRE ROAD SUITE 3
EGG HARBOR TOWNSHIP NJ
08234-5837
US

IV. Provider business mailing address

3205 FIRE RD STE 3
EGG HARBOR TOWNSHIP NJ
08234-5884
US

V. Phone/Fax

Practice location:
  • Phone: 609-407-1113
  • Fax: 609-407-1218
Mailing address:
  • Phone: 609-407-1113
  • Fax: 609-407-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number22935
License Number StateNJ

VIII. Authorized Official

Name: BARBARA CIARAMELLA
Title or Position: ADMINISTRATOR
Credential:
Phone: 609-383-6493