Healthcare Provider Details

I. General information

NPI: 1093867830
Provider Name (Legal Business Name): SURGICARE SURGICAL ASSOCIATES OF FAIRLAWN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-01 BROADWAY STE 1
FAIR LAWN NJ
07410-6003
US

IV. Provider business mailing address

85 HARRISTOWN RD STE 200
GLEN ROCK NJ
07452-3323
US

V. Phone/Fax

Practice location:
  • Phone: 201-703-8487
  • Fax: 201-971-6585
Mailing address:
  • Phone: 201-834-1100
  • Fax: 201-599-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN HAJJAR
Title or Position: CEO AND CHAIRMAN
Credential:
Phone: 201-834-1100