Provider Demographics
NPI:1275940306
Name:ORTHOPAEDIC ASSOCIATES OF FAIR LAWN, LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF FAIR LAWN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-366-8800
Mailing Address - Street 1:85 HARRISTOWN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3329
Mailing Address - Country:US
Mailing Address - Phone:844-366-8800
Mailing Address - Fax:
Practice Address - Street 1:85 HARRISTOWN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3329
Practice Address - Country:US
Practice Address - Phone:844-366-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06309600207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty