Provider Demographics
NPI:1326211509
Name:MAHWAH VALLEY ORTHOPEDIC ASSOCIATES
Entity Type:Organization
Organization Name:MAHWAH VALLEY ORTHOPEDIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-818-4344
Mailing Address - Street 1:400 FRANKLIN TPKE
Mailing Address - Street 2:STE 100
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3516
Mailing Address - Country:US
Mailing Address - Phone:201-818-4344
Mailing Address - Fax:201-818-2710
Practice Address - Street 1:400 FRANKLIN TPKE
Practice Address - Street 2:STE 100
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3516
Practice Address - Country:US
Practice Address - Phone:201-818-4344
Practice Address - Fax:201-818-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA53478207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1199840001Medicare NSC
NJF02920Medicare UPIN