Provider Demographics
NPI:1235289521
Name:EDISON METUCHEN ORTHOPAEDIC GROUP PA
Entity Type:Organization
Organization Name:EDISON METUCHEN ORTHOPAEDIC GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-839-1930
Mailing Address - Street 1:10 PARSONAGE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2475
Mailing Address - Country:US
Mailing Address - Phone:732-494-6226
Mailing Address - Fax:732-494-8762
Practice Address - Street 1:10 PARSONAGE RD STE 500
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2475
Practice Address - Country:US
Practice Address - Phone:732-494-6226
Practice Address - Fax:732-494-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0345620002Medicare ID - Type Unspecified
NJC12136Medicare ID - Type Unspecified
NJ501515Medicare ID - Type Unspecified