Healthcare Provider Details

I. General information

NPI: 1780673327
Provider Name (Legal Business Name): LAKEWOOD SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 ROUTE 70, SUITE 2000
LAKEWOOD NJ
08701-5947
US

IV. Provider business mailing address

1215 ROUTE 70, SUITE 2000
LAKEWOOD NJ
08701-5947
US

V. Phone/Fax

Practice location:
  • Phone: 732-719-1800
  • Fax: 732-719-1801
Mailing address:
  • Phone: 732-719-1800
  • Fax: 732-719-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number23286
License Number StateNJ

VIII. Authorized Official

Name: MR. JONATHAN BAILEY
Title or Position: OFFICER/AO
Credential: MHA
Phone: 203-609-1168