Provider Demographics
NPI:1073759015
Name:GLOUCESTER COUNTY SURGERY CENTER, LLC
Entity type:Organization
Organization Name:GLOUCESTER COUNTY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-478-4222
Mailing Address - Street 1:163 BRIDGETON PIKE
Mailing Address - Street 2:BUILDING B
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2669
Mailing Address - Country:US
Mailing Address - Phone:856-478-4222
Mailing Address - Fax:856-478-4408
Practice Address - Street 1:163 BRIDGETON PIKE
Practice Address - Street 2:BUILDING B
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-2669
Practice Address - Country:US
Practice Address - Phone:856-478-4222
Practice Address - Fax:856-478-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400190493261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical