Provider Demographics
NPI:1487821518
Name:NEW JERSEY ORTHOPEDIC ASSOCIATES
Entity Type:Organization
Organization Name:NEW JERSEY ORTHOPEDIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BANZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-780-8811
Mailing Address - Street 1:4247 ROUTE 9 N
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8307
Mailing Address - Country:US
Mailing Address - Phone:732-780-8811
Mailing Address - Fax:
Practice Address - Street 1:4247 ROUTE 9 N
Practice Address - Street 2:BUILDING 1
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8307
Practice Address - Country:US
Practice Address - Phone:732-780-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ204C00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ011496Medicare PIN