Provider Demographics
NPI:1972706034
Name:CENTER FOR ADVANCED SPORTS MEDICINE, KNEE AND SHOULDER, LLC
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED SPORTS MEDICINE, KNEE AND SHOULDER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEVEY, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-598-9199
Mailing Address - Street 1:90 MILLBURN AVE
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1945
Mailing Address - Country:US
Mailing Address - Phone:908-598-9199
Mailing Address - Fax:973-762-4518
Practice Address - Street 1:90 MILLBURN AVE
Practice Address - Street 2:SUITE 204A
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:908-598-9199
Practice Address - Fax:973-762-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA062614207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherFEDERAL TAX ID#