Provider Demographics
NPI:1679728901
Name:ESSEX SPECIALIZED SURGICAL INSTITUTE LLC
Entity type:Organization
Organization Name:ESSEX SPECIALIZED SURGICAL INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-750-0400
Mailing Address - Street 1:562 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1900
Mailing Address - Country:US
Mailing Address - Phone:732-846-2501
Mailing Address - Fax:
Practice Address - Street 1:475 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4197
Practice Address - Country:US
Practice Address - Phone:732-750-0400
Practice Address - Fax:732-750-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0206733Medicaid
NJ164138Medicare PIN