Provider Demographics
NPI:1083777825
Name:ORTHOPAEDIC SURGICAL CONSULTANT PC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGICAL CONSULTANT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-556-4700
Mailing Address - Street 1:9921 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8347
Mailing Address - Country:US
Mailing Address - Phone:718-238-5565
Mailing Address - Fax:718-748-3526
Practice Address - Street 1:9921 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8347
Practice Address - Country:US
Practice Address - Phone:718-238-5565
Practice Address - Fax:718-748-3526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186226174400000X
NY149171174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS2413OtherOXFORD
NYP475372OtherOXFORD INSURANCE
NY186226COSOtherWORKERS COMP
NY1C2731OtherPHS
NYRV043D8610OtherBLUE CROSS
NY149171OtherHIP
NYJL073G5810OtherEMPIRE BLUE CROSS
NY0060015OtherGHI
NY0814039Medicaid
NYP475372OtherOXFORD
NY00889818Medicaid
NY5710697012OtherCIGNA
NY0119170OtherAETNA
NY186226OtherHIP
NY149171COSOtherWORKERS COMP
NY2C2126OtherPHS
NYP475372OtherOXFORD INSURANCE
NYNS2413OtherOXFORD
NY5710697012OtherCIGNA
NY1C2731OtherPHS