Healthcare Provider Details

I. General information

NPI: 1639452444
Provider Name (Legal Business Name): CHILDREN'S AMBULATORY SURGERY CENTER OF NEW JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14-01 BROADWAY
FAIR LAWN NJ
07410-2001
US

IV. Provider business mailing address

85 HARRISTOWN RD SUITE 200
GLEN ROCK NJ
07452-3307
US

V. Phone/Fax

Practice location:
  • Phone: 291-791-0100
  • Fax: 201-791-8800
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: DR. JOHN H HAJJAR
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 201-834-1100