Provider Demographics
NPI:1598021586
Name:GARDEN STATE ORTHOPAEDIC ASSOCAITES, P.A.
Entity Type:Organization
Organization Name:GARDEN STATE ORTHOPAEDIC ASSOCAITES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-791-4434
Mailing Address - Street 1:28-04 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3913
Mailing Address - Country:US
Mailing Address - Phone:201-791-4434
Mailing Address - Fax:
Practice Address - Street 1:28-12 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3913
Practice Address - Country:US
Practice Address - Phone:201-475-8482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARDEN STATE ORTHOPAEDIC ASSOCIATES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy