Provider Demographics
NPI:1780845651
Name:RECONSTRUCTIVE ORTHOPEDICS OF CENTRAL NJ LLC
Entity Type:Organization
Organization Name:RECONSTRUCTIVE ORTHOPEDICS OF CENTRAL NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHOTTENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-222-8858
Mailing Address - Street 1:3 PROGRESS ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1180
Mailing Address - Country:US
Mailing Address - Phone:908-222-8858
Mailing Address - Fax:908-222-8857
Practice Address - Street 1:3 PROGRESS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1180
Practice Address - Country:US
Practice Address - Phone:908-222-8858
Practice Address - Fax:908-222-8857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02668300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD96588Medicare UPIN