Provider Demographics
NPI:1003384918
Name:PREFERRED PEDIATRIC ORTHOPEDIC SURGERY LLC
Entity type:Organization
Organization Name:PREFERRED PEDIATRIC ORTHOPEDIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ORTHOPEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:AVRUM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-639-2656
Mailing Address - Street 1:106 PROSPECT STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4433
Mailing Address - Country:US
Mailing Address - Phone:201-639-2656
Mailing Address - Fax:201-345-4405
Practice Address - Street 1:106 PROSPECT STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4433
Practice Address - Country:US
Practice Address - Phone:201-639-2656
Practice Address - Fax:201-345-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty