Provider Demographics
NPI:1609331693
Name:ORTHOPAEDIC SPORTS MEDICINE AND REHABILITATION CENTER, P.A.
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPORTS MEDICINE AND REHABILITATION CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LISSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-741-2313
Mailing Address - Street 1:80 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5727
Mailing Address - Country:US
Mailing Address - Phone:732-741-2313
Mailing Address - Fax:732-219-7655
Practice Address - Street 1:735 N BEERS ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1515
Practice Address - Country:US
Practice Address - Phone:732-741-2313
Practice Address - Fax:732-219-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty