Provider Demographics
NPI:1144406521
Name:EASTERN ORTHOPEDIC ASSOCIATES, MD PA
Entity Type:Organization
Organization Name:EASTERN ORTHOPEDIC ASSOCIATES, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-836-5332
Mailing Address - Street 1:222 CEDAR LANE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666
Mailing Address - Country:US
Mailing Address - Phone:201-836-5332
Mailing Address - Fax:201-836-4002
Practice Address - Street 1:222 CEDAR LANE
Practice Address - Street 2:SUITE 120
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-836-5332
Practice Address - Fax:201-836-4002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN ORTHOPEDICS,MD,PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-15
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03477300207X00000X
NJ25MA04787900207X00000X
NJ25MA05444400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ458477Medicare UPIN