Provider Demographics
NPI:1164708806
Name:CHAMPION ORTHOPEDICS
Entity Type:Organization
Organization Name:CHAMPION ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-689-2603
Mailing Address - Street 1:3635 QUAKERBRIDGE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1247
Mailing Address - Country:US
Mailing Address - Phone:609-689-2603
Mailing Address - Fax:609-689-4640
Practice Address - Street 1:3635 QUAKERBRIDGE RD STE 3
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1247
Practice Address - Country:US
Practice Address - Phone:609-689-2603
Practice Address - Fax:609-689-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04745000207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty