Provider Demographics
NPI:1275170797
Name:MODERN ORTHOPAEDICS OF NEW JERSEY
Entity Type:Organization
Organization Name:MODERN ORTHOPAEDICS OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:HART
Authorized Official - Last Name:DENOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-898-5999
Mailing Address - Street 1:PO BOX 4239
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-4239
Mailing Address - Country:US
Mailing Address - Phone:201-572-7982
Mailing Address - Fax:
Practice Address - Street 1:2025 HAMBURG TPKE STE C
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6250
Practice Address - Country:US
Practice Address - Phone:973-898-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty