{
"Npi": {
"NPI": "1639703895",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PERFORMANCE SURGICAL CENTER, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 339",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PARK RIDGE",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07656-0339",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "201-799-4010",
"MailingAddressFaxNumber": "201-746-9104",
"FirstLinePracticeLocationAddress": "1084 MAIN AVE FL 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLIFTON",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07011-2330",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "973-473-4040",
"PracticeLocationAddressFaxNumber": "516-775-8618",
"EnumerationDate": "02/26/2020",
"LastUpdateDate": "08/14/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCOTT",
"AuthorizedOfficialFirstName": "MARVEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "212-203-1835",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}