Organization
PAVONIA SURGICAL CENTER, LLC
Active
Other names
PRISM Surgery Center at Union
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN A MAGNIFICO (VP, ASC OPERATIONS)
(201) 216-1700
Entity
Organization
Contact information
Practice address
855 LEHIGH AVE STE 203, UNION, NJ 07083-7631
(201) 216-1700
Mailing address
420 MOUNTAIN AVE FL 4, NEW PROVIDENCE, NJ 07974-2736
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52773021
—
NJ
Enumeration date
09/22/2006
Last updated
02/05/2024
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