New Jersey Department of Health

EX was

CY 2017 FINANCIAL REPORT
LICENSED AMBULATORY CARE FACILITIES
SUBJECT TO THE AMBULATORY ASSESSMENT

Refer to the accompanying instructions to fill out this form.

 

Name and Address of Facility

Surgery Center, LLC
190 Midland Avenue
Saddle Brook, NJ 07663

License Number
23116

 

NJ Tax Identi?cation Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

81-4094159
A 
Line
Payer . . -
No. All Gross Charges Gross Receipts 
1 Medicare (Fee-for-Service and/or HMO) 0 0 0
2 Medicaid (Fee?for?Service and/or HMO) 0 0 0
3 Other Government Payer 0 0 0
4 Commercial 197 5,377,263.17 1,170,402.81
5 Self Pay 2 171,510.10 2,200.00
6 Others 6,478 66,970,456.55 12.655.452.48
7 Totals 6,676 72,519,229.82 13,828.055.29
If CY 2017 Gross Receipts are for less than 12 months, check here: 
Voluntarily Submitted Information A 
for Charity Care Services All Visits Gross Charges Gross Receipts
Reduced or No-Fee Care t?atients? Based Upon Ability to Pay 0 0 0
Certi?ed By (Print Nam Title
Yan Moshe CEO
Signature Telephone Number Date
201-549-9998 0510312018
Name of License Holde 'di?zgent rom L?k?ove)
Surge 
Signature Date
0510312018

 

 

 

 

HFEL-5
MAR 18