Provider Demographics
NPI:1194716191
Name:AMBULATORY SURGICAL CENTER OF UNION COUNTY, LLC
Entity type:Organization
Organization Name:AMBULATORY SURGICAL CENTER OF UNION COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-688-2700
Mailing Address - Street 1:950 W CHESTNUT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6950
Mailing Address - Country:US
Mailing Address - Phone:908-688-2700
Mailing Address - Fax:908-688-7424
Practice Address - Street 1:950 W CHESTNUT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6950
Practice Address - Country:US
Practice Address - Phone:908-688-2700
Practice Address - Fax:908-688-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23028261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001124OtherBC/BS
NJ071764Medicare PIN