Provider Demographics
NPI:1417999772
Name:ORTHOPEDIC AND SPORTS MEDICINE CENTER OF NEW JERSEY PA
Entity Type:Organization
Organization Name:ORTHOPEDIC AND SPORTS MEDICINE CENTER OF NEW JERSEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVATSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-587-1111
Mailing Address - Street 1:PO BOX 31433
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06150-1433
Mailing Address - Country:US
Mailing Address - Phone:201-587-1111
Mailing Address - Fax:
Practice Address - Street 1:2 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5214
Practice Address - Country:US
Practice Address - Phone:201-587-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04325000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCA3691OtherRAILROAD MEDIARE GROUP #
NJ0038167OtherAETNA HMO GROUP #
NJ8426670OtherAETNA PPO GROUP #
NJ114781200OtherDEPARTMENT OF LABOR
NJ540909Medicare PIN