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NPI Code Detail

MEDICARE: IRONBOUND ENDO SURGICAL CENTER, INC.

MEDICARE: IRONBOUND ENDO SURGICAL CENTER, INC.
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
1261QA1903XAmbulatory Surgical Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538389812
Entity Type Code : Organization
Provider Name (Legal Business Name) : IRONBOUND ENDO SURGICAL CENTER, INC.
Provider Business Mailing Address
First Line : 24-28 MERCHANT STREET
Second Line :
City : NEWARK
State : NJ
Zip : 07105-2847
Country : US
Telephone Number : 973-344-4787
Fax Number : 973-344-5881
Provider Business Practice Location Address
First Line : 24-28 MERCHANT STREET
Second Line :
City : NEWARK
State : NJ
Zip : 07105-2847
Country : US
Telephone Number : 973-344-4787
Fax Number : 973-344-5881
Authorized Official
Title or Position : OWNER/MD
Name : DOMENICA M BARRITTA
Credential : MD
Telephone Number : 973-344-4787
Provider Enumeration Date : 04/27/2007
Last Update Date : 12/08/2022

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