Healthcare Provider Details

I. General information

NPI: 1275930216
Provider Name (Legal Business Name): JACKSON SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 S COOKS BRIDGE RD SUITE L2
JACKSON NJ
08527-2524
US

IV. Provider business mailing address

27 S COOKS BRIDGE RD STE L2
JACKSON NJ
08527-2524
US

V. Phone/Fax

Practice location:
  • Phone: 972-763-3893
  • Fax: 972-692-6745
Mailing address:
  • Phone: 732-928-1099
  • Fax: 732-833-1690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TERESA DANNA
Title or Position: OFFICER / AUTHORIZED OFFICIAL
Credential:
Phone: 972-763-3890