Provider Demographics
NPI:1679712319
Name:UNIVERSITY ORTHOPAEDIC CENTER PA
Entity Type:Organization
Organization Name:UNIVERSITY ORTHOPAEDIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LONGOBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-343-1717
Mailing Address - Street 1:433 HACKENSACK AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6319
Mailing Address - Country:US
Mailing Address - Phone:201-343-1717
Mailing Address - Fax:201-343-3217
Practice Address - Street 1:433 HACKENSACK AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6319
Practice Address - Country:US
Practice Address - Phone:201-343-1717
Practice Address - Fax:201-343-3217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty