Provider Demographics
NPI:1922459445
Name:ENGLEWOOD KNEE & SPORTS MEDICINE, P.C.
Entity Type:Organization
Organization Name:ENGLEWOOD KNEE & SPORTS MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DERAMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-567-5700
Mailing Address - Street 1:370 GRAND AVE., SUITE 100
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4154
Mailing Address - Country:US
Mailing Address - Phone:201-567-5700
Mailing Address - Fax:201-567-8049
Practice Address - Street 1:224 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-6411
Practice Address - Country:US
Practice Address - Phone:201-567-5700
Practice Address - Fax:201-567-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies