Healthcare Provider Details

I. General information

NPI: 1457538639
Provider Name (Legal Business Name): SURGICENTER OF VINELAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 S LINCOLN AVE
VINELAND NJ
08361-7802
US

IV. Provider business mailing address

251 S LINCOLN AVE
VINELAND NJ
08361-7802
US

V. Phone/Fax

Practice location:
  • Phone: 856-691-8188
  • Fax: 856-691-0421
Mailing address:
  • Phone: 856-691-8188
  • Fax: 856-691-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAUREN MAGNIFICO
Title or Position: VP ASC OPERATIONS
Credential:
Phone: 201-216-1700