Provider Demographics
NPI:1679690218
Name:ORANGETOWN ORTHOPEDIC ASSOCIATES,LLP
Entity Type:Organization
Organization Name:ORANGETOWN ORTHOPEDIC ASSOCIATES,LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-359-1877
Mailing Address - Street 1:99 DUTCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2106
Mailing Address - Country:US
Mailing Address - Phone:845-359-1877
Mailing Address - Fax:845-359-2449
Practice Address - Street 1:99 DUTCH HILL RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2106
Practice Address - Country:US
Practice Address - Phone:845-359-1877
Practice Address - Fax:845-359-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1671681174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01087383Medicaid
NY00497585Medicaid
NY16Q951Medicare ID - Type UnspecifiedDR. SIMON
NY01G081Medicare ID - Type UnspecifiedDR. BEREZIN
NYB14962Medicare UPIN
NY00497585Medicaid
NY01087383Medicaid
NY46D951Medicare ID - Type UnspecifiedDR. SEMBLE
NY380691Medicare ID - Type UnspecifiedDR. BRIEF
NYH16044Medicare UPIN