Provider Demographics
NPI:1861782591
Name:CENTER FOR AMBULATORY AND MINIMALLY INVASIVE SURGERY LLC
Entity type:Organization
Organization Name:CENTER FOR AMBULATORY AND MINIMALLY INVASIVE SURGERY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:D
Authorized Official - Last Name:DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-747-7110
Mailing Address - Street 1:234 INDUSTRIAL WAY W
Mailing Address - Street 2:BUILDING B, SUITE 101
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4244
Mailing Address - Country:US
Mailing Address - Phone:732-229-8400
Mailing Address - Fax:732-358-0217
Practice Address - Street 1:234 INDUSTRIAL WAY W
Practice Address - Street 2:BUILDING B, SUITE 101
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-4244
Practice Address - Country:US
Practice Address - Phone:732-229-8400
Practice Address - Fax:732-358-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical