Provider Demographics
NPI:1518033893
Name:ADVANCED ORTHOPEDICS AND SPORTS MEDICINE INSTITUTE, P.C.
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDICS AND SPORTS MEDICINE INSTITUTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ABBE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-616-6738
Mailing Address - Street 1:301 PROFESSIONAL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7904
Mailing Address - Country:US
Mailing Address - Phone:732-720-2555
Mailing Address - Fax:732-720-2556
Practice Address - Street 1:301 PROFESSIONAL VIEW DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7904
Practice Address - Country:US
Practice Address - Phone:732-720-2555
Practice Address - Fax:732-720-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2022-12-13
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
NJ163495Medicare PIN
NJ0519800002Medicare NSC