Provider Demographics
NPI:1578920773
Name:PERFORMANCE ORTHOPAEDIC SPECIALISTS, LLC
Entity Type:Organization
Organization Name:PERFORMANCE ORTHOPAEDIC SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-689-6266
Mailing Address - Street 1:246 HAMBURG TPKE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2156
Mailing Address - Country:US
Mailing Address - Phone:973-689-6266
Mailing Address - Fax:973-689-6264
Practice Address - Street 1:246 HAMBURG TPKE
Practice Address - Street 2:SUITE 302
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2156
Practice Address - Country:US
Practice Address - Phone:973-689-6266
Practice Address - Fax:973-689-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty