Provider Demographics
NPI:1083975817
Name:ORTHOPAEDIC TRAUMA INSTITUTE PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC TRAUMA INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:V
Authorized Official - Last Name:PETROSINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-974-0404
Mailing Address - Street 1:2315 HIGHWAY 34
Mailing Address - Street 2:SUITE D
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1444
Mailing Address - Country:US
Mailing Address - Phone:732-974-0404
Mailing Address - Fax:732-974-2653
Practice Address - Street 1:2315 HIGHWAY 34
Practice Address - Street 2:SUITE D
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1444
Practice Address - Country:US
Practice Address - Phone:732-974-0404
Practice Address - Fax:732-974-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08156400207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DT5898OtherRAILROAD MEDICARE
6723970001Medicare NSC
255721Medicare PIN