MEDICARE: SUBURBAN ENDOSCOPY 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	22335	NJ

General Provider Information

NPI Number	:	1235178146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUBURBAN ENDOSCOPY CENTER, LLC

Provider Business Mailing Address
First Line	:	799 BLOOMFIELD AVE
Second Line	:	STE 101
City	:	VERONA
State	:	NJ
Zip	:	07044-1301
Country	:	US
Telephone Number	:	973-571-1600
Fax Number	:	973-571-1882

Provider Business Practice Location Address
First Line	:	799 BLOOMFIELD AVE
Second Line	:	STE 101
City	:	VERONA
State	:	NJ
Zip	:	07044-1301
Country	:	US
Telephone Number	:	973-571-1600
Fax Number	:	973-571-1882

Authorized Official
Title or Position	:	MEDICARE AUTHORIZED OFFICIAL
Name	:	JONATHAN BAILEY
Credential	:
Telephone Number	:	203-609-1168

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	01/14/2025

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