1962990804 NPI number — ROTHMAN INSTITUTE OF NEW JERSEY P A

Table of content: (NPI 1962990804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962990804 NPI number — ROTHMAN INSTITUTE OF NEW JERSEY P A

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
ROTHMAN INSTITUTE OF NEW JERSEY P A
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:
ROTHMAN ORTHOPAEDICS: FORMERLY BRIELLE ORTHOPAEDICS
Provider Other Organization Name Type Code:
5
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:
1962990804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
833 CHESTNUT ST STE 520
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-4414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-339-3733
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
457 JACK MARTIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08724-7776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-321-9999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PINO
Authorized Official First Name:
GINA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
267-339-3500

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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