MEDICARE: SOUTH JERSEY SURGICAL CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1124181128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH JERSEY SURGICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	150 CENTURY PKWY
Second Line	:	SUITE C
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-1129
Country	:	US
Telephone Number	:	856-608-8860
Fax Number	:	856-608-8866

Provider Business Practice Location Address
First Line	:	150 CENTURY PKWY
Second Line	:	SUITE C
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-1129
Country	:	US
Telephone Number	:	856-608-8860
Fax Number	:	856-608-8866

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARC LESLIE KAHN
Credential	:	MD
Telephone Number	:	856-608-8860

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	08/22/2020

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