Healthcare Provider Details

I. General information

NPI: 1043384704
Provider Name (Legal Business Name): AMBULATORY SURGERY CENTER AT OLD BRIDGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/19/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PERRINE RD SUITE 408
OLD BRIDGE NJ
08857-2843
US

IV. Provider business mailing address

400 PERRINE RD SUITE 408
OLD BRIDGE NJ
08857-2843
US

V. Phone/Fax

Practice location:
  • Phone: 732-533-9222
  • Fax: 732-553-9227
Mailing address:
  • Phone: 732-533-9222
  • Fax: 732-553-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number22900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SAID SAMRA
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 732-553-9222