PREMIER SURGICAL PAVILION LLC NPI 1538466453

NPI Information

NPI: 1538466453
Provider Name: PREMIER SURGICAL PAVILION, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 31D2022665

Address:
145 ROSEVILLE AVE
NEWARK, NJ
ZIP 07107
Phone: (201) 488-2101
Get Directions

PREMIER SURGICAL PAVILION, LLC is an ambulatory surgical clinic center in Newark, NJ. PREMIER SURGICAL PAVILION, LLC NPI is 1538466453. The provider is registered as an organization entity type.

The provider's business location address is:

145 ROSEVILLE AVE
NEWARK, NJ
ZIP 07107-618
Phone: (201) 488-2101
Fax: (201) 488-3929

The provider's authorized official is Michael Eugene Jones .
The authorized official title is Medical Director and has the following contact phone number (212) 223-0716.

The CLIA number assigned to this NPI record is 31D2022665 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/13/2011 and was last updated on 5/11/2012.

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	261QA1903X	Clinic/Center	Ambulatory Surgical	70781	NEW JERSEY	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	31C0001004	OTHER	NEW JERSEY	CCN

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

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.

« Previous NPI

Next NPI »