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General NPI Number Information
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NPI Number | 1548327224
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Entity Type | Organization
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Legal Business Name | BERGEN AMBULATORY SURGERY CENTER
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 190 MIDLAND AVE
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-6408
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Country | US
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Telephone | 973-405-6888
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Fax | 973-405-6889
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Provider Business Mailing Address
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Address Line | 190 MIDLAND AVE
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-6408
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Country | US
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Telephone | 973-405-6888
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Fax | 973-405-6889
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. TAMARA E DUNAEV
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Credential |
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Telephone | 973-405-6888
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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 | 23116
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License Number State | NJ
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