=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619819620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JABUSH ACUTE SURGICAL CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2026
-----------------------------------------------------
Last Update Date | 04/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 US HIGHWAY 206 APT A
-----------------------------------------------------
City | STANHOPE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07874-3325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-850-9548
-----------------------------------------------------
Fax | 908-315-9597
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 US HIGHWAY 206 APT A
-----------------------------------------------------
City | STANHOPE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07874-3325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | JONDAVID JABUSH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 908-463-4251
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------