Provider Demographics
NPI:1528104080
Name:SURGICAL CENTER AT CEDAR KNOLLS LLC
Entity type:Organization
Organization Name:SURGICAL CENTER AT CEDAR KNOLLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MHA
Authorized Official - Phone:973-292-0700
Mailing Address - Street 1:197 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-2101
Mailing Address - Country:US
Mailing Address - Phone:973-292-0700
Mailing Address - Fax:973-292-0773
Practice Address - Street 1:197 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2101
Practice Address - Country:US
Practice Address - Phone:973-292-0700
Practice Address - Fax:973-292-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23363261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical