Healthcare Provider Details

I. General information

NPI: 1255352712
Provider Name (Legal Business Name): METROPOLITAN SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 HACKENSACK AVE LL01
HACKENSACK NJ
07601
US

IV. Provider business mailing address

433 HACKENSACK AVE LL01
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-527-6800
  • Fax: 201-342-9383
Mailing address:
  • Phone: 201-527-6800
  • Fax: 201-342-9383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number23995
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. RAPHAEL LONGOBARDI
Title or Position: PRESIDENT
Credential:
Phone: 201-343-1717