Provider Demographics
NPI:1962435990
Name:NORTHERN MONMOUTH REGIONAL SURGERY CENTER LLC
Entity type:Organization
Organization Name:NORTHERN MONMOUTH REGIONAL SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-609-1168
Mailing Address - Street 1:195 US HIGHWAY 9
Mailing Address - Street 2:STE 210
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8293
Mailing Address - Country:US
Mailing Address - Phone:732-358-6500
Mailing Address - Fax:732-358-6501
Practice Address - Street 1:195 US HIGHWAY 9
Practice Address - Street 2:STE 210
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8293
Practice Address - Country:US
Practice Address - Phone:732-358-6500
Practice Address - Fax:732-358-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24059261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31C0001199Medicare Oscar/Certification
NJ103561Medicare PIN