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General NPI Number Information
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NPI Number | 1639561293
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Entity Type | Organization
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Legal Business Name | MULBERRY AMBULATORY SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 393-397 MULBERRY STREET
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City | NEWARK
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State | NJ
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Zip | 07012-3417
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Country | US
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Telephone | 929-400-2159
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9425
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City | NEW YORK
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State | NY
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Zip | 10087-9425
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Country | US
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Telephone | 212-874-3384
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Fax |
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Authorized Official
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Title or Position | OWNER/ DIRECTOR
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Name | DR. DOMENICA M BARRITTA
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Credential | M.D.
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Telephone | 929-400-2159
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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 | 25MA07669400
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License Number State | NJ
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