Provider Demographics
NPI:1073951513
Name:BODY IN MOTION SPORTS & ORTHOPAEDICS, INC.
Entity Type:Organization
Organization Name:BODY IN MOTION SPORTS & ORTHOPAEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:LO
Authorized Official - Phone:732-244-8700
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-0385
Mailing Address - Country:US
Mailing Address - Phone:201-848-5656
Mailing Address - Fax:201-848-5567
Practice Address - Street 1:784 FRANKLIN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1306
Practice Address - Country:US
Practice Address - Phone:201-848-5656
Practice Address - Fax:201-848-5567
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BODY IN MOTION SPORT & ORTHOPAEDICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45OR00005400332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0068225Medicaid
NJ1227140001Medicare NSC