1609898691 NPI number — ORTHOPAEDIC AND SPORTS SPECIALISTS, PC

Table of content: (NPI 1609898691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609898691 NPI number — ORTHOPAEDIC AND SPORTS SPECIALISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC AND SPORTS SPECIALISTS, PC
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:
1609898691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
798 S ROUTE 73
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BERLIN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08091-2620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-809-9001
Provider Business Mailing Address Fax Number:
856-809-9003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
289 WHITE HORSE PIKE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
ATCO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08004-2257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-809-9001
Provider Business Practice Location Address Fax Number:
856-809-9003
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROMERO
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MGR.
Authorized Official Telephone Number:
856-809-9001

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MA46475 , 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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