Provider Demographics
NPI:1437371762
Name:ORTHOPAEDIC SURGERY SPECIALIST OF MONTCLAIR, LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGERY SPECIALIST OF MONTCLAIR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-744-7900
Mailing Address - Street 1:103 PARK ST
Mailing Address - Street 2:SUITE #1G
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-5913
Mailing Address - Country:US
Mailing Address - Phone:973-744-7900
Mailing Address - Fax:973-744-7995
Practice Address - Street 1:103 PARK ST
Practice Address - Street 2:SUITE #1G
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-5913
Practice Address - Country:US
Practice Address - Phone:973-744-7900
Practice Address - Fax:973-744-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA067272207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083931Medicare ID - Type Unspecified