MEDICARE: NORTH JERSEY SURGERY CENTER

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	23278	NJ

General Provider Information

NPI Number	:	1871510610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH JERSEY SURGERY CENTER

Provider Business Mailing Address
First Line	:	520 SYLVAN AVE
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-3022
Country	:	US
Telephone Number	:	201-816-1991
Fax Number	:	201-816-9001

Provider Business Practice Location Address
First Line	:	520 SYLVAN AVE
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-3022
Country	:	US
Telephone Number	:	201-816-1991
Fax Number	:	201-816-9001

Authorized Official
Title or Position	:	ADMINISTRATOR/DIRECTOR OF NURSING
Name	:	MRS. JULIE HATULAN
Credential	:	BSBA, BSN, RN, CGRN
Telephone Number	:	201-816-1991

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	09/15/2008

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