Provider Demographics
NPI:1386064624
Name:ROCHESTER IMPERIAL SURGICAL CENTER LLC
Entity type:Organization
Organization Name:ROCHESTER IMPERIAL SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJOY
Authorized Official - Middle Name:
Authorized Official - Last Name:BANERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-732-1161
Mailing Address - Street 1:36243 INLAND VALLEY DR
Mailing Address - Street 2:STE 10
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-9549
Mailing Address - Country:US
Mailing Address - Phone:951-735-7246
Mailing Address - Fax:951-268-9516
Practice Address - Street 1:36243 INLAND VALLEY DR
Practice Address - Street 2:STE 10
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9549
Practice Address - Country:US
Practice Address - Phone:951-735-7246
Practice Address - Fax:951-268-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical