Provider Demographics
NPI:1386816056
Name:SPORTS MEDICINE NEW JERSEY PA
Entity Type:Organization
Organization Name:SPORTS MEDICINE NEW JERSEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINTRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-946-2101
Mailing Address - Street 1:475 COUNTY ROAD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:475 COUNTY ROAD
Practice Address - Street 2:SUITE 520
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1059
Practice Address - Country:US
Practice Address - Phone:732-946-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB05602400207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ034889Medicare PIN