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General NPI Number Information
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NPI Number | 1780217034
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Entity Type | Organization
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Legal Business Name | MODERN MEDICINE SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 02/14/2020
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 633 FROM RD
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City | PARAMUS
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State | NJ
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Zip | 07652-3514
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Country | US
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Telephone | 551-284-7220
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Fax | 551-284-7221
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Provider Business Mailing Address
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Address Line | 633 FROM RD
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City | PARAMUS
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State | NJ
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Zip | 07652-3514
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Country | US
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Telephone | 551-284-7220
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Fax | 551-284-7221
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CIRO RANDAZZO
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Credential | MD
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Telephone | 551-284-7220
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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 |
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License Number State |
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