Provider Demographics
NPI:1619757366
Name:ORTHOMD LLC
Entity Type:Organization
Organization Name:ORTHOMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-355-1166
Mailing Address - Street 1:227 WEST ST APT 2322
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-7694
Mailing Address - Country:US
Mailing Address - Phone:734-355-1166
Mailing Address - Fax:
Practice Address - Street 1:2175 LEMOINE AVE STE 401A
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6019
Practice Address - Country:US
Practice Address - Phone:917-242-4585
Practice Address - Fax:917-242-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty