Provider Demographics
NPI:1174677991
Name:WESTWOOD ORTHOPEDIC GROUP
Entity Type:Organization
Organization Name:WESTWOOD ORTHOPEDIC GROUP
Other - Org Name:RAPHAEL K LEVINE MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-666-3241
Mailing Address - Street 1:354 OLD HOOK ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-666-3241
Mailing Address - Fax:201-666-6876
Practice Address - Street 1:354 OLD HOOK ROAD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-666-3241
Practice Address - Fax:201-666-6876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA28536207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ86491793BMedicaid
NY906891OtherEMPIRE BCBS
B5038OtherOXFORD
NJ86491793BMedicaid
B5038OtherOXFORD