Provider Demographics
NPI:1508974338
Name:ORTHOPAEDIC & JOINT RECONSTRUCTION SURGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC & JOINT RECONSTRUCTION SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-533-1050
Mailing Address - Street 1:22 OLD SHORT HILLS ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-533-1050
Mailing Address - Fax:973-533-1235
Practice Address - Street 1:22 OLD SHORT HILLS ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-533-1050
Practice Address - Fax:973-533-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
196318Medicare ID - Type Unspecified