1215015078 NPI number — NORTHERN NEW JERSEY ORTHOPEDIC SPECIALISTS

Table of content: (NPI 1215015078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215015078 NPI number — NORTHERN NEW JERSEY ORTHOPEDIC SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN NEW JERSEY ORTHOPEDIC SPECIALISTS
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:
1215015078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 CAMPUS DR STE 1S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARSIPPANY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07054-4405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-538-4444
Provider Business Mailing Address Fax Number:
973-538-0420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROUTE 94 STE 5E BLDG E
Provider Second Line Business Practice Location Address:
VIKING VILLAGE
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-827-4700
Provider Business Practice Location Address Fax Number:
973-827-0439
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
MARC
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ORTHOPEDIC SURGEON
Authorized Official Telephone Number:
973-538-4444

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA50155 , 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: 0246808 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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