Provider Demographics
NPI:1962755561
Name:RENAISSANCE SURGERY CENTER
Entity type:Organization
Organization Name:RENAISSANCE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPORINO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:862-247-8080
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-0555
Mailing Address - Country:US
Mailing Address - Phone:862-247-8080
Mailing Address - Fax:
Practice Address - Street 1:190 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-6408
Practice Address - Country:US
Practice Address - Phone:862-247-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23116261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical