Provider Demographics
NPI:1538102157
Name:ANDOVER ORTHOPAEDIC SURGERY
Entity Type:Organization
Organization Name:ANDOVER ORTHOPAEDIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BACALOGLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-579-7443
Mailing Address - Street 1:280 NEWTON SPARTA RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2775
Mailing Address - Country:US
Mailing Address - Phone:973-293-7513
Mailing Address - Fax:973-293-7571
Practice Address - Street 1:452 US HIGHWAY 206
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:NJ
Practice Address - Zip Code:07827
Practice Address - Country:US
Practice Address - Phone:973-293-7513
Practice Address - Fax:973-293-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ540798Medicare ID - Type Unspecified