Provider Demographics
NPI:1821774076
Name:ORTHOPAEDIC SPORTS MEDICINE AND REHABILITATION CENTER, P.A.
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPORTS MEDICINE AND REHABILITATION CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-741-2313
Mailing Address - Street 1:2-12 CORBETT WAY
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4251
Mailing Address - Country:US
Mailing Address - Phone:848-257-1800
Mailing Address - Fax:848-257-1155
Practice Address - Street 1:2-12 CORBETT WAY
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-4251
Practice Address - Country:US
Practice Address - Phone:848-257-1800
Practice Address - Fax:848-257-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty