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General NPI Number Information
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NPI Number | 1083131544
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Entity Type | Organization
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Legal Business Name | CORE SURGERY CENTER LLC
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 256 STUYVESANT AVENUE
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City | LYNDHURST
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State | NJ
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Zip | 07071
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Country | US
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Telephone | 201-905-1113
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Fax | 201-255-0102
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Provider Business Mailing Address
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Address Line | 256 STUYVESANT AVENUE
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City | LYNDHURST
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State | NJ
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Zip | 07071
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Country | US
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Telephone | 201-905-4113
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Fax | 201-255-0102
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JAGDIP DESAI
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Credential | MD
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Telephone | 908-705-6857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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