1477723641 NPI number — PASSAIC COUNTY ORTHOPAEDIC ASSOCIATES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477723641 NPI number — PASSAIC COUNTY ORTHOPAEDIC ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PASSAIC COUNTY ORTHOPAEDIC ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477723641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1360 CLIFTON AVE
Provider Second Line Business Mailing Address:
SUITE #96
Provider Business Mailing Address City Name:
CLIFTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07012-1343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-458-0772
Provider Business Mailing Address Fax Number:
973-458-0864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 CLIFTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07013-3518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-458-0772
Provider Business Practice Location Address Fax Number:
973-458-0864
Provider Enumeration Date:
03/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOLE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
LIONEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-458-0772

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MA058929 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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