VANGUARD SURGICAL CENTER, LLC. - NPI NUMBER 1023350907

Summary

Provider Name: VANGUARD SURGICAL CENTER, LLC.

NPI Number: 1023350907

Clasification: Clinic/Center (261QA1903X)

Specialization: Ambulatory Surgical

Address:
113 ESSEX ST
MAYWOOD, NJ
ZIP 07607

Phone Number: (201) 251-7725



Detailed Information

VANGUARD SURGICAL CENTER, LLC. is an ambulatory surgical clinic/center in Maywood, NJ. The assigned NPI number for this provider is 1023350907 and is registered as an organization entity type.

The provider's business address is:

113 ESSEX ST
MAYWOOD, NJ
ZIP 07607-020
Phone: (201) 251-7725

The provider's authorized official is Dante A Implicito .
The authorized official title is Managing Member and has the following contact phone number (201) 251-7725.

The enumeration date for this NPI number is 3/19/2013 and was last updated on 8/20/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QA1903X Clinic/Center Ambulatory Surgical Yes

NPI Record

No. Field Name Field Value
1 NPI 1023350907
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name VANGUARD SURGICAL CENTER, LLC.
5 Provider First Line Business Practice Location Address 113 ESSEX ST
6 Provider Business Practice Location Address City Name MAYWOOD
7 Provider Business Practice Location Address State Name NJ
8 Provider Business Practice Location Address Postal Code 076071020
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 2012517725
11 Provider Enumeration Date 3/19/2013
12 Last Update Date 8/20/2013
13 Authorized Official Last Name IMPLICITO
14 Authorized Official First Name DANTE
15 Authorized Official Middle Name A
16 Authorized Official Title or Position MANAGING MEMBER
17 Authorized Official Telephone Number 2012517725
18 Healthcare Provider Taxonomy Code 1 261QA1903X
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Is Organization Subpart N
21 Authorized Official Name Prefix Text DR.
22 Authorized Official Credential Text M.D.

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This page was last updated on: 9/11/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.