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General NPI Number Information
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NPI Number | 1841444593
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Entity Type | Organization
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Legal Business Name | TEANECK SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 11/07/2008
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 730 PALISADE AVE FL 2
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City | TEANECK
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State | NJ
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Zip | 07666-3144
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Country | US
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Telephone | 201-928-2160
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Fax | 201-287-8385
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Provider Business Mailing Address
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Address Line | 730 PALISADE AVE FL 2
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City | TEANECK
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State | NJ
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Zip | 07666-3144
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Country | US
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Telephone | 201-928-2160
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Fax | 201-287-8385
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEN LEE
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Credential | MD
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Telephone | 201-928-2160
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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 | 24302
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License Number State | NJ
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