Provider Demographics
NPI:1467502260
Name:NORTH JERSEY PROSTHETICS & ORTHOTICS, INC.
Entity Type:Organization
Organization Name:NORTH JERSEY PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARANO
Authorized Official - Suffix:
Authorized Official - Credentials:LPO- CO
Authorized Official - Phone:201-943-4448
Mailing Address - Street 1:39 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1436
Mailing Address - Country:US
Mailing Address - Phone:201-943-4448
Mailing Address - Fax:201-941-1711
Practice Address - Street 1:39 BROAD AVE
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1436
Practice Address - Country:US
Practice Address - Phone:201-943-4448
Practice Address - Fax:201-941-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00007800335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5487501Medicaid
NJ5487501Medicaid