Healthcare Provider Details

I. General information

NPI: 1356510408
Provider Name (Legal Business Name): HACKENSACK SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 KOTTE PL.
HACKENSACK NJ
07601
US

IV. Provider business mailing address

19 KOTTE PL
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-1921
  • Fax: 201-996-9400
Mailing address:
  • Phone: 201-996-1921
  • Fax: 201-996-9400

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: DR. RICHARD TODD BRAVER
Title or Position: PRESIDENT
Credential: DPM
Phone: 201-966-1921