Provider Demographics
NPI:1972673713
Name:HAND SURGERY & REHABILITATION CENTER OF NEW JERSEY, PA
Entity Type:Organization
Organization Name:HAND SURGERY & REHABILITATION CENTER OF NEW JERSEY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALLET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-983-4263
Mailing Address - Street 1:5000 SAGEMORE DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-983-4263
Mailing Address - Fax:856-983-9362
Practice Address - Street 1:5000 SAGEMORE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4307
Practice Address - Country:US
Practice Address - Phone:856-983-4263
Practice Address - Fax:856-983-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ240192086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ34931OtherAETNA GROUP NUMBER
NJ9661087OtherGHI GROUP NUMBER
NJIL2400OtherHEALTHNET GROUP NUMBER
NJ0550440000OtherKEYSTONE GROUP NUMBER
NJ3733521BOtherCIGNA GROUP NUMBER
NJ658819OtherHIGHMARK GROUP NUMBER
NJ714037OtherHORIZON GROUP NUMBER
NJ0201950001OtherMEDICARE NSC
NJ0550440000OtherAMERIHEALTH GROUP NUMBER
NJ736734OtherUNITED HEALTH GROUP NUMBE
NJ0550440000OtherKEYSTONE GROUP NUMBER
NJ714037Medicare PIN