Provider Demographics
NPI:1548848120
Name:AMBULATORY SURGICAL CENTER OF BERGENFIELD LLC
Entity type:Organization
Organization Name:AMBULATORY SURGICAL CENTER OF BERGENFIELD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLO RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-374-8900
Mailing Address - Street 1:1 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2125
Mailing Address - Country:US
Mailing Address - Phone:201-374-8900
Mailing Address - Fax:
Practice Address - Street 1:1 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2125
Practice Address - Country:US
Practice Address - Phone:201-374-8900
Practice Address - Fax:201-384-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical