Healthcare Provider Details

I. General information

NPI: 1023070026
Provider Name (Legal Business Name): TOMS RIVER SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 HOOPER AVENUE SUITE 301
TOMS RIVER NJ
08753-2895
US

IV. Provider business mailing address

1430 HOOPER AVENUE SUITE 301
TOMS RIVER NJ
08753-2895
US

V. Phone/Fax

Practice location:
  • Phone: 732-240-2277
  • Fax: 732-240-5428
Mailing address:
  • Phone: 732-240-2277
  • Fax: 732-240-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number22908
License Number StateNJ

VIII. Authorized Official

Name: JONATHAN BAILEY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 203-609-1168