Provider Demographics
NPI:1730127101
Name:BEDMINSTER ORTHOPAEDICS & SPORTS MEDICINE PA
Entity Type:Organization
Organization Name:BEDMINSTER ORTHOPAEDICS & SPORTS MEDICINE PA
Other - Org Name:ROBERT J. D'AGOSTINI, JR., MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAGOSTINI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:908-234-2002
Mailing Address - Street 1:1590 ROUTE 206 NORTH
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921
Mailing Address - Country:US
Mailing Address - Phone:908-234-2002
Mailing Address - Fax:908-234-2022
Practice Address - Street 1:1590 ROUTE 206 NORTH
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921
Practice Address - Country:US
Practice Address - Phone:908-234-2002
Practice Address - Fax:908-234-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04611100207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2060302Medicaid
NJ050180Medicare ID - Type Unspecified
NJ2060302Medicaid