Healthcare Provider Details

I. General information

NPI: 1851743074
Provider Name (Legal Business Name): DELAWARE VALLEY SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 SAGEMORE DR SUITE 6103
MARLTON NJ
08053-3900
US

IV. Provider business mailing address

6000 SAGEMORE DR SUITE 6103
MARLTON NJ
08053-3900
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-0072
  • Fax: 856-988-7308
Mailing address:
  • Phone: 856-988-0072
  • Fax: 856-988-7308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberNJR24708
License Number StateNJ

VIII. Authorized Official

Name: DR. GEORGE TALIADOUROS
Title or Position: MANAGER
Credential: MD
Phone: 856-988-0072