Provider Demographics
NPI:1730410697
Name:SURGICAL SPECIALISTS AT PRINCETON LLC
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS AT PRINCETON LLC
Other - Org Name:
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 1:136 MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5789
Mailing Address - Country:US
Mailing Address - Phone:609-799-1130
Mailing Address - Fax:609-799-1140
Practice Address - Street 1:136 MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5789
Practice Address - Country:US
Practice Address - Phone:609-799-1130
Practice Address - Fax:609-799-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24430261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222121Medicare PIN