Provider Demographics
NPI:1083932768
Name:ORTHOPAEDIC SPECIALTY GROUP LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALTY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-696-0900
Mailing Address - Street 1:994 W SHERMAN AVE
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6932
Mailing Address - Country:US
Mailing Address - Phone:856-696-0900
Mailing Address - Fax:856-692-4769
Practice Address - Street 1:994 W SHERMAN AVE
Practice Address - Street 2:BUILDING 1
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6932
Practice Address - Country:US
Practice Address - Phone:856-696-0900
Practice Address - Fax:856-692-4769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty