1275574667 NPI number — ADVANCED ORTHOPAEDIC CENTERS PA

Table of content: (NPI 1275574667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275574667 NPI number — ADVANCED ORTHOPAEDIC CENTERS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED ORTHOPAEDIC CENTERS PA
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:
ORTHOPAEDIC ASSOCIATES OF WOODBURY
Provider Other Organization Name Type Code:
4
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:
1275574667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
414 TATUM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08096-3499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-848-3880
Provider Business Mailing Address Fax Number:
856-848-4895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 TATUM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08096-3499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-848-3880
Provider Business Practice Location Address Fax Number:
856-848-4895
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALIN
Authorized Official First Name:
DARCY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
856-848-3880

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XS0106X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2658500 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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