Provider Demographics
NPI:1699272112
Name:HANOVER HILLS SURGERY CENTER, LLC
Entity type:Organization
Organization Name:HANOVER HILLS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-902-2222
Mailing Address - Street 1:83 HANOVER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1508
Mailing Address - Country:US
Mailing Address - Phone:973-805-9960
Mailing Address - Fax:973-805-9970
Practice Address - Street 1:83 HANOVER RD STE 100
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1508
Practice Address - Country:US
Practice Address - Phone:973-805-9960
Practice Address - Fax:973-805-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical