Provider Demographics
NPI:1679520340
Name:CENTRAL PHYSICIANS & SURGEONS PA
Entity Type:Organization
Organization Name:CENTRAL PHYSICIANS & SURGEONS PA
Other - Org Name:CENTRAL ORTHOPEDIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRIEDENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-561-8787
Mailing Address - Street 1:403 COMMERCE LN STE 3
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-2513
Mailing Address - Country:US
Mailing Address - Phone:856-767-8787
Mailing Address - Fax:856-767-6140
Practice Address - Street 1:403 COMMERCE LN STE 3
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-2513
Practice Address - Country:US
Practice Address - Phone:856-767-8787
Practice Address - Fax:856-767-6140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ33179207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3018407Medicaid
NJ527858Medicare PIN
NJW94767Medicare UPIN