Provider Demographics
NPI:1760435473
Name:ORTHOPEDIC ASSOCIATES OF ENGLEWOOD
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF ENGLEWOOD
Other - Org Name:ENGLEWOOD ORTHOPEDIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-569-2770
Mailing Address - Street 1:401 S VAN BRUNT ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4604
Mailing Address - Country:US
Mailing Address - Phone:201-569-2770
Mailing Address - Fax:201-569-1774
Practice Address - Street 1:401 S VAN BRUNT ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4604
Practice Address - Country:US
Practice Address - Phone:201-569-2770
Practice Address - Fax:201-569-1774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2855909Medicaid
CJ8809OtherRAILROAD MEDICARE
CJ8809OtherRAILROAD MEDICARE
NJ2855909Medicaid