Healthcare Provider Details

I. General information

NPI: 1104068485
Provider Name (Legal Business Name): MILLENNIUM AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 OCEAN AVENUE 1ST FLOOR
BROOKLYN NY
11230
US

IV. Provider business mailing address

1408 OCEAN AVENUE 1ST FLOOR
BROOKLYN NY
11230
US

V. Phone/Fax

Practice location:
  • Phone: 718-725-8900
  • Fax: 718-876-0343
Mailing address:
  • Phone: 718-725-8900
  • Fax: 718-876-0343

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: MR. MICHAEL ASH
Title or Position: ADMINISTRATOR
Credential: CST, FA
Phone: 718-725-8900