=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942937487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SURGERY CENTER AT DEBORAH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2022
-----------------------------------------------------
Last Update Date | 06/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 EARLIN AVE STE 320
-----------------------------------------------------
City | BROWNS MILLS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08015-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-297-5279
-----------------------------------------------------
Fax | 609-726-6302
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 EARLIN AVE STE 320
-----------------------------------------------------
City | BROWNS MILLS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08015-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-297-5279
-----------------------------------------------------
Fax | 609-726-6302
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER AND AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | JENNIFER BOYD BALDOCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-234-5954
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------