Healthcare Provider Details

I. General information

NPI: 1104883990
Provider Name (Legal Business Name): SURGICARE AMBULATORY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WESTCHESTER AVE SUITE 102
BRONX NY
10461-4500
US

IV. Provider business mailing address

3250 WESTCHESTER AVE SUITE 102
BRONX NY
10461-4500
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-9000
  • Fax: 718-518-0495
Mailing address:
  • Phone: 718-518-9000
  • Fax: 718-518-0495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7000253R
License Number StateNY

VIII. Authorized Official

Name: MR. SALVATORE DANIEL BUFFA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-518-9000