| Organization Name: | CSR OUTPATIENT MEDICAL SERVICES, LLC |
| NPI Number: | 1093149650 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES MICELI (CEO) |
| Mailing Address: | 585 Broadway Massapequa |
| State: | NY US |
| Postal Code: | 117585023 |
| Phone Number: | 5167971234 |
| Fax Number: | 5167971932 |
| NPI Enumeration Date: | 08/30/2013 |
| NPI Last Update Date: | 08/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |