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General NPI Number Information
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NPI Number | 1669895512
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Entity Type | Organization
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Legal Business Name | AMBULATORY SURGICAL CENTER OF SOMERVILLE LLC
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 1 US HIGHWAY 206
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City | SOMERVILLE
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State | NJ
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Zip | 08876-4101
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Country | US
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Telephone | 908-393-8360
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Fax | 908-393-8375
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Provider Business Mailing Address
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Address Line | 1 US HIGHWAY 206
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City | SOMERVILLE
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State | NJ
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Zip | 08876-4101
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Country | US
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Telephone | 908-393-8360
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Fax | 908-393-8375
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED SIGNER
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Name | JONATHAN BAILEY
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Credential |
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Telephone | 203-609-1168
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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 | 24098
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License Number State | NJ
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