Provider Demographics
NPI:1669459855
Name:PROFESSIONAL ORTHOPAEDIC ASSOC PA
Entity Type:Organization
Organization Name:PROFESSIONAL ORTHOPAEDIC ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-530-4949
Mailing Address - Street 1:776 SHREWSBURY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3006
Mailing Address - Country:US
Mailing Address - Phone:732-530-4949
Mailing Address - Fax:732-530-3618
Practice Address - Street 1:776 SHREWSBURY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3006
Practice Address - Country:US
Practice Address - Phone:732-530-4949
Practice Address - Fax:732-530-3618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0250340001OtherMEDICARE DMER IDENTIFIER
NJ0000405555Medicare ID - Type UnspecifiedMEDICARE GROUP ID #