Provider Demographics
NPI:1326361569
Name:WEST ORANGE ORTHOPAEDIC ASSOC. P.A.
Entity Type:Organization
Organization Name:WEST ORANGE ORTHOPAEDIC ASSOC. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-376-2800
Mailing Address - Street 1:609 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081
Mailing Address - Country:US
Mailing Address - Phone:973-376-2800
Mailing Address - Fax:
Practice Address - Street 1:609 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081
Practice Address - Country:US
Practice Address - Phone:973-376-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST ORANGE ORTHOPAEDIC ASSOC. P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-02
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO15660207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ157828Medicare PIN