Healthcare Provider Details

I. General information

NPI: 1336209451
Provider Name (Legal Business Name): SADDLE RIVER VALLEY SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W RIDGEWOOD AVE G3
PARAMUS NJ
07652-2359
US

IV. Provider business mailing address

1 W RIDGEWOOD AVE STE G3
PARAMUS NJ
07652-2361
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-2676
  • Fax:
Mailing address:
  • Phone: 201-447-2676
  • Fax: 201-447-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number23238
License Number StateNJ

VIII. Authorized Official

Name: CHANNING CHIN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 201-447-2676