Provider Demographics
NPI:1568481513
Name:ADVANCED ORHTOPEDIC & SPORTSMEDICINE
Entity Type:Organization
Organization Name:ADVANCED ORHTOPEDIC & SPORTSMEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARZULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-840-8500
Mailing Address - Street 1:457 JACK MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7776
Mailing Address - Country:US
Mailing Address - Phone:732-840-8500
Mailing Address - Fax:
Practice Address - Street 1:2164 HIGHWAY 35
Practice Address - Street 2:BUILDING C
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1013
Practice Address - Country:US
Practice Address - Phone:732-974-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ316559Medicare ID - Type Unspecified