Healthcare Provider Details

I. General information

NPI: 1235321571
Provider Name (Legal Business Name): SURGICARE SURGICAL ASSOCIATES OF MAHWAH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FRANKLIN TPKE
MAHWAH NJ
07430-3516
US

IV. Provider business mailing address

555 KINDERKAMACK RD
ORADELL NJ
07649-1517
US

V. Phone/Fax

Practice location:
  • Phone: 201-791-4544
  • Fax:
Mailing address:
  • Phone: 201-834-1100
  • Fax:

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: JOHN HAJJAR
Title or Position: PRESIDENT
Credential: MD
Phone: 201-791-4544