Provider Demographics
NPI:1699855973
Name:CENTER FOR SPECIAL PROCEDURES, LLC
Entity type:Organization
Organization Name:CENTER FOR SPECIAL PROCEDURES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-886-1234
Mailing Address - Street 1:475 HIGHWAY 70
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5897
Mailing Address - Country:US
Mailing Address - Phone:732-886-1234
Mailing Address - Fax:732-886-2345
Practice Address - Street 1:475 HIGHWAY 70
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5897
Practice Address - Country:US
Practice Address - Phone:732-886-1234
Practice Address - Fax:732-886-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2022353531/000261QA1903X
NJ25MA07431300261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical