Provider Demographics
NPI:1679752166
Name:ORTHOPAEDIC ASSOCIATES PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES PA
Other - Org Name:COHEN, BERGER, GREENBLUM ASSOCIATES, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-794-6008
Mailing Address - Street 1:PO BOX 973
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-0973
Mailing Address - Country:US
Mailing Address - Phone:201-794-6008
Mailing Address - Fax:201-794-6190
Practice Address - Street 1:1035 ROUTE 46 STE G2
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2430
Practice Address - Country:US
Practice Address - Phone:201-794-6008
Practice Address - Fax:201-794-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
526693Medicare PIN
NJ0719910001Medicare NSC