Healthcare Provider Details

I. General information

NPI: 1184499196
Provider Name (Legal Business Name): PERFORMANCE SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 OCEAN AVE FL 1
BROOKLYN NY
11230-3814
US

IV. Provider business mailing address

2050 LAKEVILLE RD
NEW HYDE PARK NY
11040-1639
US

V. Phone/Fax

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

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: SANDRO STARNA
Title or Position: CHIEF FINANCIAL OFFICER AND PRINCIP
Credential:
Phone: 718-725-8900