Provider Demographics
NPI:1255479937
Name:WEST ORANGE ORTHOPAEDICS & SPORTS MEDICINE PA
Entity Type:Organization
Organization Name:WEST ORANGE ORTHOPAEDICS & SPORTS MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-654-3505
Mailing Address - Street 1:596 OCOEE COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4219
Mailing Address - Country:US
Mailing Address - Phone:407-654-3505
Mailing Address - Fax:407-654-4956
Practice Address - Street 1:596 OCOEE COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4219
Practice Address - Country:US
Practice Address - Phone:407-654-3505
Practice Address - Fax:407-654-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL01537207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2192742OtherUNITED HEALTHCARE
FL059865800Medicaid
CB0528OtherMEDICARE RAILROAD
00331OtherBC/BS
01084794OtherAMERIGOUP
4557847OtherAETNA
00331OtherBC/BS