=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669446852
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VOORHEES NJ ENDOSCOPY ASC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2006
-----------------------------------------------------
Last Update Date | 05/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 93 COOPER RD STE 100
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-4910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-770-1920
-----------------------------------------------------
Fax | 856-770-1925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 93 COOPER RD STE 100
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-4910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-770-1920
-----------------------------------------------------
Fax | 856-770-1925
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JEFFREY E. SNODGRASS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-665-1283
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 24436
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------