Provider Demographics
NPI:1669635157
Name:SPORTS MEDICINE PHYSICIAN ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SPORTS MEDICINE PHYSICIAN ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MENDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-265-7747
Mailing Address - Street 1:550 KINDERKAMACK RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1500
Mailing Address - Country:US
Mailing Address - Phone:201-265-7747
Mailing Address - Fax:201-265-7748
Practice Address - Street 1:550 KINDERKAMACK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1500
Practice Address - Country:US
Practice Address - Phone:201-265-7747
Practice Address - Fax:201-265-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty