Provider Demographics
NPI:1275700247
Name:SWEENEY ORTHOPEDIC GROUP PA
Entity Type:Organization
Organization Name:SWEENEY ORTHOPEDIC GROUP PA
Other - Org Name:NEW JERSEY SPINE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:908-232-2700
Mailing Address - Street 1:1122 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1419
Mailing Address - Country:US
Mailing Address - Phone:908-232-2700
Mailing Address - Fax:908-232-3763
Practice Address - Street 1:1122 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1419
Practice Address - Country:US
Practice Address - Phone:908-232-2700
Practice Address - Fax:908-232-3763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03623900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD19602Medicare UPIN