Provider Demographics
NPI:1528017654
Name:PEDIATRIC ORTHOPEDIC ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:PEDIATRIC ORTHOPEDIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TARTAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:732-390-1160
Mailing Address - Street 1:585 CRANBURY RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4026
Mailing Address - Country:US
Mailing Address - Phone:732-390-1160
Mailing Address - Fax:732-390-8449
Practice Address - Street 1:585 CRANBURY RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4026
Practice Address - Country:US
Practice Address - Phone:732-390-1160
Practice Address - Fax:732-390-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3095703Medicaid
NJ3095703Medicaid