Provider Demographics
NPI:1669503355
Name:PROFESSIONAL SPORTS MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:PROFESSIONAL SPORTS MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAJART
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ATC
Authorized Official - Phone:201-265-4400
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-0377
Mailing Address - Country:US
Mailing Address - Phone:201-265-4400
Mailing Address - Fax:201-265-7355
Practice Address - Street 1:440 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-2302
Practice Address - Country:US
Practice Address - Phone:201-265-4400
Practice Address - Fax:201-265-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04765400207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty