Provider Demographics
NPI:1821224429
Name:NEW JERSEY ORTHOPAEDIC INSTITUTE, LLC
Entity Type:Organization
Organization Name:NEW JERSEY ORTHOPAEDIC INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-694-2690
Mailing Address - Street 1:504 VALLEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3534
Mailing Address - Country:US
Mailing Address - Phone:973-694-2690
Mailing Address - Fax:973-694-2692
Practice Address - Street 1:504 VALLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3534
Practice Address - Country:US
Practice Address - Phone:973-694-2690
Practice Address - Fax:973-694-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0600-3432-20207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ162301Medicare PIN