Provider Demographics
NPI:1770655870
Name:ORTHOPEDICS AT 215 UNION AVENUE
Entity Type:Organization
Organization Name:ORTHOPEDICS AT 215 UNION AVENUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:NORDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-685-8500
Mailing Address - Street 1:215 UNION AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3063
Mailing Address - Country:US
Mailing Address - Phone:908-685-8500
Mailing Address - Fax:908-685-8009
Practice Address - Street 1:215 UNION AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3063
Practice Address - Country:US
Practice Address - Phone:908-685-8500
Practice Address - Fax:908-685-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07898900207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095713Medicare ID - Type UnspecifiedPROVIDER ID