Provider Demographics
NPI:1669663399
Name:VAN GROUW ORTHOPAEDIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:VAN GROUW ORTHOPAEDIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN GROUW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-444-5770
Mailing Address - Street 1:44 GODWIN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1969
Mailing Address - Country:US
Mailing Address - Phone:201-444-5770
Mailing Address - Fax:201-444-3746
Practice Address - Street 1:44 GODWIN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1969
Practice Address - Country:US
Practice Address - Phone:201-444-5770
Practice Address - Fax:201-444-3746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05590500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCD5410OtherRR MDCR GROUP #
NJ0500620001Medicare NSC
GR769308Medicare PIN