Healthcare Provider Details

I. General information

NPI: 1780217034
Provider Name (Legal Business Name): MODERN MEDICINE SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 FROM RD
PARAMUS NJ
07652-3514
US

IV. Provider business mailing address

633 FROM RD
PARAMUS NJ
07652-3514
US

V. Phone/Fax

Practice location:
  • Phone: 551-284-7220
  • Fax: 551-284-7221
Mailing address:
  • Phone: 551-284-7220
  • Fax: 551-284-7221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CIRO RANDAZZO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 551-284-7220