Provider Demographics
NPI:1477723641
Name:PASSAIC COUNTY ORTHOPAEDIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:PASSAIC COUNTY ORTHOPAEDIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LIONEL
Authorized Official - Last Name:HOLE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:973-458-0772
Mailing Address - Street 1:1360 CLIFTON AVE
Mailing Address - Street 2:SUITE #96
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1343
Mailing Address - Country:US
Mailing Address - Phone:973-458-0772
Mailing Address - Fax:973-458-0864
Practice Address - Street 1:1011 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3518
Practice Address - Country:US
Practice Address - Phone:973-458-0772
Practice Address - Fax:973-458-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA058929207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081694Medicare PIN