Healthcare Provider Details

I. General information

NPI: 1457653834
Provider Name (Legal Business Name): SURGICARE SURGICAL ASSOCIATES OF JERSEY CITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 GRAND ST
JERSEY CITY NJ
07304-3417
US

IV. Provider business mailing address

85 HARRISTOWN RD
GLEN ROCK NJ
07452-3307
US

V. Phone/Fax

Practice location:
  • Phone: 201-834-1100
  • Fax: 201-599-8338
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 State

VIII. Authorized Official

Name: MR. CHRIS DALTON
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 201-834-1100