Provider Demographics
NPI:1659738193
Name:ACTIVE ORTHOPEDICS & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:ACTIVE ORTHOPEDICS & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LISAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-343-2277
Mailing Address - Street 1:440 OLD HOOK RD
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-2302
Mailing Address - Country:US
Mailing Address - Phone:201-358-0707
Mailing Address - Fax:201-358-9777
Practice Address - Street 1:1 BAY AVE
Practice Address - Street 2:2 NORTH ORTHOPEDICS
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4837
Practice Address - Country:US
Practice Address - Phone:973-680-7831
Practice Address - Fax:973-680-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty