Healthcare Provider Details

I. General information

NPI: 1699055541
Provider Name (Legal Business Name): EXCEL SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 ESSEX ST
HACKENSACK NJ
07601-2066
US

IV. Provider business mailing address

321 ESSEX ST
HACKENSACK NJ
07601-2066
US

V. Phone/Fax

Practice location:
  • Phone: 201-692-9800
  • Fax: 201-692-9801
Mailing address:
  • Phone: 201-692-9800
  • Fax: 201-692-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number23264
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. YAN MOSHE
Title or Position: OWNER/MANAGER
Credential:
Phone: 212-795-2222