Provider Demographics
NPI:1518492289
Name:NEW JERSEY ORTHOPEDIC AND SPORTS MEDICINE L.L.C.
Entity Type:Organization
Organization Name:NEW JERSEY ORTHOPEDIC AND SPORTS MEDICINE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-334-4787
Mailing Address - Street 1:24 MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2847
Mailing Address - Country:US
Mailing Address - Phone:973-344-4787
Mailing Address - Fax:
Practice Address - Street 1:99 MADISON ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2107
Practice Address - Country:US
Practice Address - Phone:973-334-4787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty