Provider Demographics
NPI:1922090950
Name:GARDEN STATE ORTHOPAEDIC CENTER, INC.
Entity Type:Organization
Organization Name:GARDEN STATE ORTHOPAEDIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HABERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:201-337-5566
Mailing Address - Street 1:9 POST RD
Mailing Address - Street 2:SUITE 0P-1
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-1618
Mailing Address - Country:US
Mailing Address - Phone:201-337-5566
Mailing Address - Fax:201-337-1456
Practice Address - Street 1:9 POST RD
Practice Address - Street 2:SUITE 0P-1
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-1618
Practice Address - Country:US
Practice Address - Phone:201-337-5566
Practice Address - Fax:201-337-1456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ36877OtherAETNA PROVIDER NUMBER
NJ3897206Medicaid
NJ36877OtherAETNA PROVIDER NUMBER
NJ3897206Medicaid
NJ=========OtherHORIZON BCBS PROVIDER #