Healthcare Provider Details

I. General information

NPI: 1669612990
Provider Name (Legal Business Name): TRI-STATE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WINSLOW PL 1ST FLOOR
PARAMUS NJ
07652-2709
US

IV. Provider business mailing address

3 WINSLOW PL 1ST FLOOR
PARAMUS NJ
07652-2709
US

V. Phone/Fax

Practice location:
  • Phone: 201-546-1890
  • Fax: 201-546-1893
Mailing address:
  • Phone: 201-546-1890
  • Fax: 201-546-1893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number25MB06848500
License Number StateNJ

VIII. Authorized Official

Name: DR. MICHAEL GARTNER
Title or Position: OWNER
Credential: D.O.
Phone: 201-546-1890