Provider Demographics
NPI:1447213962
Name:TRI-COUNTY ORTHOPAEDIC & SPORTS MEDICINE PA
Entity Type:Organization
Organization Name:TRI-COUNTY ORTHOPAEDIC & SPORTS MEDICINE PA
Other - Org Name:TRI-COUNTY ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-538-2334
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07962-1446
Mailing Address - Country:US
Mailing Address - Phone:973-538-2334
Mailing Address - Fax:
Practice Address - Street 1:197 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2111
Practice Address - Country:US
Practice Address - Phone:973-538-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-COUNTY ORTHOPAEDIC & SPORTS MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-07
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04208000174400000X
207X00000X, 363A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1133306Medicaid
NJ1133306Medicaid
0565190001Medicare NSC
NJD18591Medicare UPIN