Healthcare Provider Details

I. General information

NPI: 1922075969
Provider Name (Legal Business Name): SAINT MARY'S AMBULATORY SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 BERGEN BLVD
PALISADES PARK NJ
07650
US

IV. Provider business mailing address

540 BERGEN BLVD
PALISADES PARK NJ
07650-2322
US

V. Phone/Fax

Practice location:
  • Phone: 201-585-2911
  • Fax: 201-585-2977
Mailing address:
  • Phone: 201-585-2911
  • Fax: 201-585-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIEL KIM
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 201-585-2911