Provider Demographics
NPI:1609311398
Name:NORTH JERSEY SPORTS MEDICINE AND ORTHOPEDIC CENTER
Entity Type:Organization
Organization Name:NORTH JERSEY SPORTS MEDICINE AND ORTHOPEDIC CENTER
Other - Org Name:THE ORTHOPEDIC INSTITUTE OF NJ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEFALCO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:908-684-3005
Mailing Address - Street 1:108 BILBY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-4174
Mailing Address - Country:US
Mailing Address - Phone:908-684-3005
Mailing Address - Fax:908-684-3301
Practice Address - Street 1:108 BILBY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4174
Practice Address - Country:US
Practice Address - Phone:908-684-3005
Practice Address - Fax:908-684-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00420400363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty