PAVONIA SURGICAL CENTER LLC NPI 1396844429

NPI Information

NPI: 1396844429
Provider Name: PAVONIA SURGICAL CENTER, LLC

Doing Business As: PRISM SURGERY CENTER AT UNION

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
855 LEHIGH AVE STE 203
UNION, NJ
ZIP 07083
Phone: (201) 216-1700
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PAVONIA SURGICAL CENTER, LLC is a multi-specialty clinic center in Union, NJ. PAVONIA SURGICAL CENTER, LLC NPI is 1396844429. The provider is registered as an organization entity type.
The provider Is Doing Business As Prism Surgery Center At Union.

The provider's business location address is:

855 LEHIGH AVE STE 203
UNION, NJ
ZIP 07083-631
Phone: (201) 216-1700

The provider's authorized official is Lauren A Magnifico .
The authorized official title is Vp, Asc Operations and has the following contact phone number (201) 216-1700.

The CLIA number assigned to this NPI record is 31D2248223 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/22/2006 and was last updated on 2/5/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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	261QM1300X	Clinic/Center	Multi-Specialty			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	52773021	MEDICAID	NEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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