1780813261 NPI number — CTO ORTHOPAEDICS LLC

Table of content: (NPI 1780813261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780813261 NPI number — CTO ORTHOPAEDICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CTO ORTHOPAEDICS 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:
C. TOBENNA OKEZIE M.D.
Provider Other Organization Name Type Code:
3
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:
1780813261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1732
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARAMUS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07653-1732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-265-3111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 EVELYN ST
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
PARAMUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07652-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-265-3111
Provider Business Practice Location Address Fax Number:
201-265-3117
Provider Enumeration Date:
07/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
OKEZIE
Authorized Official First Name:
CHUKUEKE
Authorized Official Middle Name:
TOBENNA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
201-265-3111

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  25MA06793200 , 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)

  • Identifier: 7720106 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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