Provider Demographics
NPI:1275574667
Name:ADVANCED ORTHOPAEDIC CENTERS PA
Entity Type:Organization
Organization Name:ADVANCED ORTHOPAEDIC CENTERS PA
Other - Org Name:ORTHOPAEDIC ASSOCIATES OF WOODBURY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-848-3880
Mailing Address - Street 1:414 TATUM ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3499
Mailing Address - Country:US
Mailing Address - Phone:856-848-3880
Mailing Address - Fax:856-848-4895
Practice Address - Street 1:414 TATUM ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3499
Practice Address - Country:US
Practice Address - Phone:856-848-3880
Practice Address - Fax:856-848-4895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2658500Medicaid
NJ0606170001Medicare NSC
NJ140287Medicare PIN