Provider Demographics
NPI:1972526242
Name:SURGICARE OF CENTRAL JERSEY, LLC
Entity type:Organization
Organization Name:SURGICARE OF CENTRAL JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-769-1354
Mailing Address - Street 1:40 STIRLING RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-5900
Mailing Address - Country:US
Mailing Address - Phone:908-769-0912
Mailing Address - Fax:
Practice Address - Street 1:40 STIRLING RD
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-5900
Practice Address - Country:US
Practice Address - Phone:908-769-0912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ305444Medicare ID - Type Unspecified