MEDICARE: SUTTON AMBULATORY HEALTH 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	:	1205066297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUTTON AMBULATORY HEALTH LLC

Provider Business Mailing Address
First Line	:	1485 PALISADE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5346
Country	:	US
Telephone Number	:	201-461-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1485 PALISADE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5346
Country	:	US
Telephone Number	:	201-461-9400
Fax Number	:	201-947-4647

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY AHN
Credential	:	M.D.
Telephone Number	:	201-461-9400

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	07/23/2009

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