Provider Demographics
NPI:1588131627
Name:CENTER FOR MODERN SURGERY LLC
Entity type:Organization
Organization Name:CENTER FOR MODERN SURGERY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAW-PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-652-4800
Mailing Address - Street 1:3206 TOWER OAKS BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4254
Mailing Address - Country:US
Mailing Address - Phone:240-669-3134
Mailing Address - Fax:240-669-3053
Practice Address - Street 1:210 MEADOWLANDS PKWY STE 5
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2306
Practice Address - Country:US
Practice Address - Phone:240-669-3134
Practice Address - Fax:240-669-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1588131627OtherNPI