# AMBULATORY SURGICAL CENTER OF POMPTON LAKES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063077402
- **Authorized official:** DENISE PALLIS (DIR OF CREDENTIALING)
- **Authorized official phone:** (201) 874-9084

## Contact information

- **Practice address:** 111 WANAQUE AVE, POMPTON LAKES, NJ 07442-2101
- **Practice address phone:** (973) 225-0732
- **Practice address fax:** (973) 968-6660
- **Mailing address:** 111 WANAQUE AVE, POMPTON LAKES, NJ 07442-2101
- **Mailing address fax:** (973) 968-6660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/01/2019
- **Last updated:** 08/10/2021