1023253291 NPI number — FLORHAM PARK SURGERY CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023253291 NPI number — FLORHAM PARK SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORHAM PARK SURGERY CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023253291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
83 HANOVER RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FLORHAM PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07932-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-805-9960
Provider Business Mailing Address Fax Number:
973-805-9970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83 HANOVER RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FLORHAM PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07932-1508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-805-9960
Provider Business Practice Location Address Fax Number:
973-805-9970
Provider Enumeration Date:
12/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BAIK
Authorized Official First Name:
SEOUNG
Authorized Official Middle Name:
WON
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
732-744-9090

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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