Provider Demographics
NPI:1821139759
Name:NEW JERSEY RECONSTRUCTIVE ORTHOPAEDICS LLC
Entity Type:Organization
Organization Name:NEW JERSEY RECONSTRUCTIVE ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MNGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:BA,CPC
Authorized Official - Phone:732-255-3303
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730-0388
Mailing Address - Country:US
Mailing Address - Phone:732-279-1100
Mailing Address - Fax:
Practice Address - Street 1:2446 CHURCH RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8182
Practice Address - Country:US
Practice Address - Phone:732-279-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59450207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ011714Medicare PIN